APPEALS SPECIALIST

CGS Administrators; Nashville (TN); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with公司

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

CGS Administrators is hiring a Part A/HHH Appeals Specialist to perform non-medical reviews and process redetermination letters. This full-time, onsite role is located at One Century Plaza in Nashville, TN, and requires CMS security clearance due to government-related work.

You will compile unit reports, analyze workload, update documents, and assist with legal inquiries or administrative requests, contributing to accurate and timely appeals processing within a diverse team.

Qualifications

• High School Diploma or equivalent is required.
• 2 years in a related field.
• Proficiency in word processing and spreadsheet software.
• Excellent organizational, customer service, and written and verbal communication skills.
• Proficiency in spelling, punctuation, and grammar.

Responsibilities

• 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.

Skills

Word processing

Spreadsheets

Customer service

Written and verbal communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

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:

• High School Diploma or equivalent
• 2 years job related field.
• 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.
• Microsoft Office.
• 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.