Appeals Specialist

260 CGS Administrators, LLC; Nashville (TN); Presencial; USD 48.000 - 64.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health benefits

Dental coverage

Vision coverage

401k with match

Paid time off

On-site facilities

Education assistance

Service recognition

Discount programs

Descripción de la vacante

CGS Administrators in Nashville is seeking an Appeals Specialist (Part A/HHH) to perform non-medical reviews and process redetermination letters. The role requires a high school diploma and at least 2 years in a related field, with strong MS Word/Excel and communication skills. The position is full-time and onsite at One Century Plaza, Nashville, TN.

The team emphasizes timely, accurate processing, reporting, and potential support for legal inquiries. Sponsorship is not available at this time.

Formación

• High school diploma or equivalent required.
• Minimum 2 years in related field.
• Strong MS Word/Excel skills and good communication.
• Proficient in spelling, punctuation, and grammar.

Responsabilidades

• Performs non-medical reviews and processes redetermination letters.
• Prepares unit reports, analyzes 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.

Conocimientos

Word processing

Spreadsheet software

Organizational skills

Customer service

Written communication

Verbal communication

Judgment

Grammar

Educación

High School Diploma or equivalent

Herramientas

Microsoft Office

Descripción del empleo

Summary

We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years. Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description

Position Purpose: An Appeals Specialist performs non-medical reviews and processes redetermination letters.

Logistics: CGS - one of BlueCross BlueShield's South Carolina subsidiary companies.

Government Clearance: This position requires CMS Security Clearance as it falls within a division subject to Centers for Medicare and Medicaid Services residency requirements.

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.

Location: This position is full-time (40 hours/week) Monday-Friday located onsite at One Century Plaza, Nashville, TN.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You’ll Do

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.

To Qualify For This Position, You'll Need The Following

• Required Education: High School Diploma or equivalent
• Required Work Experience: 2 years job related field.
• Required Skills and Abilities: Demonstrated proficiency in word processing and spreadsheet software. Excellent organizational, customer service, and written and verbal communication skills. Good judgment skills. Proficiency in spelling, punctuation, and grammar skills.
• Required Software and Tools: Microsoft Office.

Work Environment

Typical office environment.

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 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.

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.

Our Company

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.