Specialist, Appeals

BlueCross BlueShield of South Carolina•Florence, SC

2d•Onsite

About The Position

An Appeals Specialist performs non-medical reviews and processes redetermination letters. This position is with Palmetto GBA, one of BlueCross BlueShield's South Carolina subsidiary companies. It requires CMS Security Clearance due to Centers for Medicare and Medicaid Services residency requirements. Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits and will receive supplemental pay until enrolled in health benefits 28 days after the hire date. The work hours are 8:00 AM – 4:30 PM, flexible after training. This position is not eligible for sponsorship now or in the future.

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.