Appeals Manager

CGS Administrators; Nashville (TN); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health benefits

401k with company match

Paid Time Off (PTO)

On-site facilities

Job summary

BlueCross BlueShield of South Carolina is seeking an Appeals Manager to lead operations for Medicare service contract activities. The role oversees staff, ensures CMS compliance, and collaborates across functions in a fast-paced environment.

The position is full-time, onsite at One Century Plaza in Nashville, TN, with occasional overtime. A U.S. citizen able to obtain a security clearance is required for consideration.

Qualifications

• Bachelor's degree required.
• 5+ years in a leadership role managing staff in Medicare or similar environment (or equivalent military leadership).
• Ability to obtain a U.S. security clearance is required.
• Strong verbal/written communication, judgment, and organizational skills.
• Proficiency in MS Office; ability to handle confidential information with discretion.

Responsibilities

• Provide management oversight of departmental staff and programs.
• Ensure CMS guidelines and performance standards are met.
• Collaborate with other departments to resolve issues.
• Participate in special projects as assigned.

Skills

Leadership experience

Verbal and written communication

Analytical thinking

Discretion with sensitive information

MS Office proficiency

Judgment and organization

Education

Bachelor's degree

Tools

Microsoft Office

Job description

SummaryWhy 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.DescriptionPosition 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 issuesParticipates in special projects as assignedTo Qualify For This Position, You'll Need The Following:Required Education: Bachelor'sRequired 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:We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.Subsidized health plans, dental and vision coverage401k retirement savings plan with company matchLife InsurancePaid Time Off (PTO)On-site cafeterias and fitness centers in major locationsEducation AssistanceService RecognitionNational discounts to movies, theaters, zoos, theme parks and moreWhat We Can Do for You: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.What to Expect Next:After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.Equal Employment Opportunity StatementBlueCross 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.