Appeals Manager

260 CGS Administrators, LLC; Nashville (TN); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina (CGS) is seeking an Appeals Manager to oversee operations for a Medicare service contract. The role requires managing staff, ensuring CMS guidelines, and coordinating with other functional teams.

The position is full-time and onsite at the One Century Plaza location in Nashville, TN, with a 40–45 hour workweek and occasional overtime. U.S. citizenship is required for government clearance.

Qualifications

• Bachelor's degree required.
• 5 years in a leadership role overseeing staff in Medicare or similar setting (or equivalent military experience).
• Excellent verbal and written communication; strong analytical and organizational skills.
• Ability to handle confidential information; proficiency with Word/Excel.
• Knowledge of CMS guidelines and performance standards would be a plus.

Responsibilities

• Oversee departmental staff and programs.
• Ensure CMS guidelines and performance standards are met.
• Collaborate with other areas to resolve issues and participate in special projects.

Skills

Verbal and written communication

Judgment and analytical thinking

Grammar and spelling

Confidential information handling

Word processing & spreadsheets

Customer service

Education

Bachelor's degree

Business Administration / Healthcare Administration (preferred)

Tools

Microsoft Office

Job description

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina… and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team! Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Position Purpose

We are currently hiring for an Appeals Manager to join BlueCross BlueShield of South Carolina. In this role as an Appeals Manager, you will be managing the successful operations of a department that is responsible for administering part of a Medicare service contract. Functional areas may include but are not limited to: quality independent contractor (QIC), administration, appeals, systems, or records.

Logistics: CGS (cgsadmin.com), – one of BlueCross BlueShield of South Carolina’s subsidiary companies. Location: This position is full-time 40-45 hours/week (45 hours due to special projects and assignments) Monday-Friday with the flexibility to begin work at 5:00am or 9:00am Central Time. This role will be onsite at the One Century Plaza location in Nashville, TN. May be necessary, given the business need to work occasional overtime.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

What You’ll Do

• Provides management oversight of departmental staff and programs.


• Ensures compliance with Center for Medicare and Medicaid Services (CMS) guidelines and performance standards.


• Collaborates with other functional areas to resolve multifunctional issues.


• Participates in special projects as assigned.

To Qualify For This Position

Required Education

Bachelor's Required

Work Experience

5 years in leadership position responsible for staff management in Medicare or similar environment or equivalent military experience in grade E4 or above.

Required Skills and Abilities

• Excellent verbal and written communication skills.


• Excellent judgment, organizational, customer service, analytical/critical thinking skills.


• Proficiency in grammar, spelling, punctuation skills.


• Basic business math proficiency.


• Ability to handle confidential or sensitive information with discretion.


• Working knowledge of word processing, spreadsheet software.

Required Software and Other Tools

• Microsoft Office.

We Prefer That You Have The Following

• Bachelor's degree-Business Administration, Business Management, Healthcare Administration, or related field.


• 7 years-in leadership position responsible for staff management in Medicare environment or equivalent military experience in grade E4 or above; experience to also include claims, medical affairs, or provider network experience.


• Ability to use complex mathematical calculations.


• Knowledge of mathematical or statistical concepts.


• Knowledge of database software.

Our comprehensive benefits package includes the following:

• 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

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Veterans Welcome!

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.

Welcome Here’s Your Smart Career Move

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!