Appeals Manager

ourhrconnect; Nashville (TN); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Health plans

401k match

Life Insurance

Paid time off

On-site facilities

Education assistance

Service recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina seeks an Appeals Manager to oversee the department responsible for administering part of a Medicare service contract, with focus on CMS guidelines and quality. This full-time, onsite role is located at One Century Plaza in Nashville, TN, with potential overtime and flexible start times; U.S.

citizenship is required to obtain security clearance. Join a diverse, community-rooted organization offering comprehensive benefits and opportunities to contribute to

Qualifications

• Bachelor's degree required.
• 5 years in leadership position responsible for staff management in Medicare or similar environment or equivalent military experience in grade E4 or above.
• Excellent verbal and written communication; strong judgment, organizational, customer service, analytical thinking.
• Working knowledge of word processing and spreadsheet software; ability to handle confidential or sensitive information with discretion.
• Microsoft Office proficiency.

Responsibilities

• 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

Skills

Verbal communication

Written communication

Judgment

Organizational skills

Customer service

Analytical thinking

Grammar and spelling

Punctuation

Discretion

Word processing

Spreadsheet

Education

Bachelor's degree

Tools

Microsoft Office

Database software

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.

Description

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, You'll Need The Following:

• 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

What 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 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, disabil