Specialist, Appeals

Southcarolinablues; Florence (SC); Hybrid; USD 38,000 - 52,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with公司

Life Insurance

Paid Time Off

Job summary

BlueCross BlueShield of South Carolina is seeking an Appeals Specialist to perform non-medical reviews and process redetermination letters, ensuring timeliness and accuracy. This role supports CMS-related requirements and uses various software tools.

You will compile unit reports, analyze workload, and update letters as needed; strong organizational and communication skills are essential. Onsite work at Florence or Columbia, SC with standard hours after training.

Qualifications

• High School Diploma or equivalent required.
• 2 years job related field experience preferred.
• Proficiency in word processing and spreadsheet software.
• Excellent organizational, customer service, and written and verbal communication skills.
• Good judgment and attention to detail.
• Proficiency in spelling, punctuation, and grammar.
• Microsoft Office proficiency required.

Responsibilities

• Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
• Prepares unit reports, analyzes workload, and processes issues using various software tools.
• Updates letters and documents within the department when necessary.
• May gather and prepare documentation for legal inquiries and administrative requests.

Skills

Communication skills

Organizational skills

Customer service

Written communication

Verbal communication

Good judgment

Spelling and grammar

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose

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

Logistics

• Palmetto GBA - 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 and Hours

Location: Onsite at 200 Dozier Blvd, Florence, SC 29501 OR 17 Technology Circle, Columbia, SC 29203

Work Hours: 8:00 AM – 4:30 PM (flexible after training)

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

Required Qualifications

• 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

Preferred Qualifications

• Medicare Part B experience

Our Comprehensive Benefits Package Includes

• 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.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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.

Veterans Welcome

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full‑time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.