Appeals Specialist

BlueCross BlueShield of South Carolina • Nashville, TN

6d • Onsite

About The Position

CGS Administrators, a subsidiary company of BlueCross BlueShield of South Carolina, is hiring a Part A/HHH Appeals Specialist. The role performs non-medical reviews and processes redetermination letters, ensuring timeliness and accuracy. It is a full-time, 40-hour-per-week position, Monday through Friday, based onsite at One Century Plaza in Nashville, Tennessee. The position requires CMS Security Clearance because it is within a division subject to Centers for Medicare and Medicaid Services residency requirements. Sponsorship is not available now or in the future.

CGS has provided administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years. The role works in a typical office environment.

Requirements

• High school diploma or equivalent.
• Two years of work experience in a job-related field.
• Demonstrated proficiency in word processing and spreadsheet software.
• Excellent organizational, customer service, written communication, and verbal communication skills.
• Good judgment skills.
• Proficiency in spelling, punctuation, and grammar.
• Proficiency with Microsoft Office.
• Ability to meet CMS Security Clearance requirements, including applicable residency requirements.

Responsibilities

• Perform non-medical reviews and process redetermination letters while ensuring timeliness and accuracy.
• Prepare unit reports, analyze and interpret workload, and process issues using various software tools.
• Update departmental letters and documents when necessary.
• Gather and prepare documentation for legal inquiries and administrative requests, as needed.

Benefits

• Subsidized health plans, with employees required to participate under the applicable Service Contract Act requirements.
• Dental coverage.
• Vision coverage.
• 401(k) retirement savings plan with company match.
• Life insurance.
• Paid time off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Education assistance.
• Service recognition.
• National discounts to movies, theaters, zoos, theme parks, and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED