Appeals Specialist (CGS Admin)

CGS Administrators, LLC•Nashville, TN

4d•Hybrid

About The Position

We are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South Carolina. In this role as Appeals Specialist, you will be required to perform non-medical reviews and process redetermination letters. BlueCross BlueShield of South Carolina has been part of the national landscape for over seven decades and is the largest insurance company in South Carolina. They are also one of the nation’s leading administrators of government contracts and operate one of the most sophisticated data processing centers in the Southeast. CGS (cgsadmin.com) is a subsidiary company of BlueCross BlueShield of South Carolina. This position is onsite with work hours starting between 6:00 AM and 7:30 AM Central Time. You will work an 8-hour shift schedule. It may be necessary, given the business need to work occasional overtime. This role is fully remote or can sit onsite at 26 Century Blvd, Suite ST610 Nashville, TN 37214 United States of America. As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Requirements

High School Diploma or equivalent
2 years job related field.
Demonstrated proficiency in word processing and spreadsheet software.
Excellent organizational, customer service, and written and verbal communication skills.
Good judgment skills.
Proficiency in spelling, punctuation, and grammar skills.
Microsoft Office.

Nice To Haves

Experience in medical claims processing, appeals, or coding strongly preferred
Medicare Part B experience preferred
Strong computer proficiency, with the ability to navigate multiple systems and work across dual screens efficiently
Intermediate-level Excel skills
Experience creating letters and documents by reviewing appeals and extracting information with a high degree of accuracy; updates departmental documents as needed.

Responsibilities

Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
Updates letter's and documents within the department when necessary.
May gather and prepare documentation for legal inquiries and administrative requests.