Appeals Specialist: Redeterminations (Hybrid)

BlueCross and BlueShield of South Carolina; Nashville (TN); Hybrid; 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

Job summary

BlueCross BlueShield of South Carolina in Nashville is seeking an Appeals Specialist to perform non-medical reviews and process redetermination letters, ensuring timeliness and accuracy. The role requires a high school diploma, 2 years of related experience, proficiency in Microsoft Office, and strong written and verbal communication.

The position offers a standard 40-hour work week and a path to a hybrid work arrangement after training.

Qualifications

• Required Education: High School Diploma or equivalent.
• Required Work Experience: 2 years job related field.
• Required Skills and Abilities: Proficiency in word processing and spreadsheet software; excellent organizational, customer service, and written and verbal communication skills; good judgment; spelling, punctuation, and grammar proficiency.

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

Communication

Organizational skills

Grammar

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina in Nashville is seeking an Appeals Specialist to perform non-medical reviews and process redetermination letters, ensuring timeliness and accuracy. The role requires a high school diploma, 2 years of related experience, proficiency in Microsoft Office, and strong written and verbal communication.

The position offers a standard 40-hour work week and a path to a hybrid work arrangement after training.