Specialist, Appeals

BlueCross BlueShield of South Carolina•Nashville, TN

2d•Hybrid

About The Position

An Appeals Specialist performs non-medical reviews and processes redetermination letters, ensuring timeliness and accuracy. The role also prepares unit reports, analyzes and interprets workload, processes issues using various software tools, and updates departmental letters and documents as needed. The specialist may gather and prepare documentation for legal inquiries and administrative requests. This is a full-time, 40-hour-per-week position, Monday through Friday, 8:00 AM to 5:00 PM CT. After successfully completing training, employees are eligible for a hybrid work arrangement. The primary work location is One Century Plaza, Nashville, Tennessee. The position requires CMS Security Clearance because it is within a division subject to Centers for Medicare and Medicaid Services residency requirements. It is not eligible for sponsorship now or in the future. The role is with CGS, a BlueCross BlueShield of South Carolina subsidiary. As the company’s federal contracts are subject to the Service Contract Act, employees cannot opt out of health benefits. Supplemental pay is provided until enrollment in health benefits 28 days after the hire date.

Requirements

High school diploma or equivalent.
Two years of experience in a job-related field.
Demonstrated proficiency in word processing and spreadsheet software.
Excellent organizational, customer service, written communication, and verbal communication skills.
Good judgment skills.
Proficiency in spelling, punctuation, and grammar.
Proficiency with Microsoft Office.
Ability to obtain CMS Security Clearance.

Responsibilities

Perform non-medical reviews and process redetermination letters, ensuring timeliness and accuracy.
Prepare unit reports and analyze and interpret workload.
Process issues using various software tools.
Update departmental letters and documents when necessary.
Gather and prepare documentation for legal inquiries and administrative requests, as needed.