Specialist, Appeals

CGS Administrators, LLC • Nashville, TN

1d • Hybrid

About The Position

Logistics: CGS –one of BlueCross BlueShield's South Carolina subsidiary companies. Location : This position is hybrid schedule 3 days onsite reporting at 26 Century Blvd Suite ST610 Nashville, 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. Welcome CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Want to work for a growing company with an innovative eye towards the future? Join us today!

Requirements

• High school diploma or equivalent
• 2 years in a job-related field
• Demonstrated proficiency in word processing and spreadsheet software
• excellent organizational, customer-service, and written and oral communications skills
• good judgment
• proficiency in spelling, punctuation and grammar
• Microsoft Office skills

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

What This Job Offers

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