Assistant, Qualified Independent Contractor

BlueCross BlueShield of South Carolina • Nashville, TN

16d • Hybrid

About The Position

Provides all redetermination case file information within the specified time requirement while maintaining accuracy and departmental standards. Suspends claims in applicable claim system and tracks all data. Logistics CGS one of BlueCross BlueShield's South Carolina subsidiary companies. This is a full-time position (40 hours/week), Monday–Friday, 8:00 AM–4:30 PM CST. The role is hybrid after training (approximately six weeks), with onsite work required at 26 Century Boulevard, Suite NT600, Nashville, TN 37214-3685. This role supports the QIC (Qualified Independent Contractor) workload tied to DME Medicare appeals. When a supplier submits a redetermination on a previously processed claim and disputes the outcome, the case advances to reconsideration conducted by the QIC. You will compile and provide the documentation packets the QIC requests. Centers for Medicare & Medicaid Services (CMS) Requirements: This position supports a federal government contract and is subject to CMS residency requirements. Candidates must have resided in the United States for at least three (3) of the last five (5) years. This is a business requirement tied to our government contracts. Residency will be verified during the background check process; candidates who do not meet this requirement will not be able to proceed.

Requirements

• High School Diploma or equivalent
• 1 year administrative support, clerical, or claims experience.
• Good organizational, decision making, customer service skills.
• Detail oriented.
• Analytical or critical thinking skills.
• Microsoft Office.

Nice To Haves

• 2 years-clerical, research, or related office experience.
• Ability to handle confidential or sensitive information with discretion.

Responsibilities

• Perform the administrative function of validating and processing reconsideration requests within designated timeliness and quality standards.
• Identify, retrieve, and prepare documentation for batching; build case files in the established format; annotate claims in the appropriate claim and internal systems for proper tracking and reporting; copy, fax, and log data.
• Maintains databases and updates the system for tracking purposes to ensure timeliness and quality standards are met.

What This Job Offers

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