Appeals & Redetermination Specialist

Southcarolinablues; Nashville (TN); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is seeking an Appeals Specialist for the Nashville, TN site. The role entails performing non-medical reviews and processing redetermination letters, preparing workload reports, and updating department documents.

Strong MS Office proficiency and excellent written/verbal communication are required. The position operates on-site in Nashville and requires CMS security clearance due to regulatory scope.

Qualifications

• High school diploma or equivalent.
• At least 2 years in a related field.
• Proficient in MS Office; strong written and verbal communication.

Responsibilities

• Performs non-medical reviews and processes redetermination letters.
• Prepares unit reports, analyzes workload, and uses various software tools.
• Updates letters and documents within the department when necessary.
• Gathers and prepares documentation for legal inquiries and administrative requests.

Skills

Word processing

Spreadsheets

Organizational skills

Customer service

Communication

Good judgment

Spelling/Grammar

MS Office

Education

High School Diploma

Tools

MS Office Suite

Job description

BlueCross BlueShield of South Carolina is seeking an Appeals Specialist for the Nashville, TN site. The role entails performing non-medical reviews and processing redetermination letters, preparing workload reports, and updating department documents.

Strong MS Office proficiency and excellent written/verbal communication are required. The position operates on-site in Nashville and requires CMS security clearance due to regulatory scope.