Appeals Specialist

BlueCross BlueShield of South Carolina•Nashville, TN

2d•Hybrid

About The Position

Location This position is hybrid schedule 3 days onsite reporting at 26 Century Blvd Suite ST610Nashville, TN 37214 and two days remote, this is a full time role (40 hours/week) Monday-Friday. As an Appeals Specialist, you'll be at the forefront of patient advocacy, reviewing and managing redeterminations and first-level appeals with precision and care. Your daily work involves analyzing comprehensive documentation, identifying missing information, ensuring timely processing, and making decisions that directly impact healthcare outcomes. You'll review cases thoroughly, update records meticulously, and communicate clear decisions through professional correspondence. This is more than data entry—you're the critical checkpoint that ensures fair healthcare decisions are made, and patients receive the answers they deserve. Work independently on a computer-based role (no phones required) and take pride in knowing your attention to detail and thoroughness makes a tangible difference in people's lives every single day. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Requirements

Required Education: High School Diploma or equivalent
Required work experience: 2 years job related field
Required Skills and abilities: 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.

Nice To Haves

Experience with Medicare and Appeals

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 letters and documents within the department when necessary
May gather and prepare documentation for legal inquiries and administrative requests

Benefits

401(k) retirement savings plan with company match.
Subsidized health plans and free vision coverage.
Life insurance.
Paid annual leave – the longer you work here, the more you earn.
Nine paid holidays.
On-site cafeterias and fitness centers in major locations.
Wellness programs and healthy lifestyle premium discount.
Tuition assistance.
Service recognition.
Incentive Plan.
Merit Plan.
Continuing education funds for additional certifications and certification renewal.