Specialist, Appeals

ourhrconnect; Florence (SC); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Health plans

401k with match

Life Insurance

PTO

Cafeterias & fitness centers

Education assistance

Service recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking an Appeals Specialist to perform non-medical reviews and process redetermination letters. This onsite role is based at facilities in Florence, SC, with standard hours and CMS clearance requirements. A High School diploma and 2 years of related experience are required.

The role emphasizes accuracy, timely processing, and strong communication skills, working in a collaborative team environment within a federally influenced program.

Qualifications

• High School Diploma or equivalent is required.
• 2 years of job-related work experience.
• Demonstrated proficiency in word processing and spreadsheet software; strong communication skills.

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

Communication

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!

Description

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: 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.

To Qualify For This Position

• 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.

We Prefer That You Have the Following

• Preferred Work Experience: Medicare Part B.

Our Comprehensive Benefits Package Includes The Following

• 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.