Appeals Specialist: Non-Medical Reviews & Redeterminations

260 CGS Administrators, LLC; Nashville (TN); Hybrid; USD 45,000 - 65,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking an Appeals Specialist in Nashville, TN. This full-time role performs non-medical reviews and processes redetermination letters, ensuring timeliness and accuracy, and supports the department with reporting and document management.

You'll work a standard 40-hour week, with a training period and a path to a hybrid work arrangement. Strong organizational and communication skills are essential to succeed in this role with our government contracts

Qualifications

• High school diploma or equivalent required.
• Minimum 2 years of related work experience.
• Proficiency with MS Word / spreadsheets and basic software tools.
• Strong written and verbal communication skills.
• Excellent organization and attention to detail.

Responsibilities

• Performs non-medical reviews and processes redetermination letters.
• Prepares unit reports and analyzes workload using various software tools.
• Updates letters and department documents as needed.
• May gather and prepare documentation for legal inquiries and administrative requests.

Skills

Word processing

Spreadsheet software

Customer service

Written and verbal communication

Good judgment

Spelling and grammar

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking an Appeals Specialist in Nashville, TN. This full-time role performs non-medical reviews and processes redetermination letters, ensuring timeliness and accuracy, and supports the department with reporting and document management.

You'll work a standard 40-hour week, with a training period and a path to a hybrid work arrangement. Strong organizational and communication skills are essential to succeed in this role with our government contracts