Specialist, Appeals
BlueCross BlueShield of South Carolina•Columbia, SC
•Onsite
About The Position
An Appeals Specialist performs non-medical reviews and processes redetermination letters. This position is with Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina. It requires CMS Security Clearance and is subject to the McNamara-O'Hara Service Contract Act (SCA), meaning employees cannot opt out of health benefits and will receive supplemental pay until enrolled in health benefits 28 days after hire. The role is located onsite in Florence, SC or Columbia, SC, with work hours from 8:00 AM – 4:30 PM, flexible after training. Sponsorship is not available.
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
- Medicare Part B.
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
- Subsidized health plans, dental and vision coverage
- 401k 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
