Specialist, Appeals

260 CGS Administrators, LLC; Nashville (TN); Hybride; USD 45 000 - 65 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Word processing

Spreadsheet software

Customer service

Written and verbal communication

Good judgment

Spelling and grammar

Formation

High School Diploma or equivalent

Outils

Microsoft Office

Description du poste

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

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 and Hours

This full-time opportunity is scheduled for 40 hours per week, Monday through Friday, from 8:00 AM to 5:00 PM CT. After successfully completing training, employees will be eligible for a hybrid work arrangement. The primary work location is 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.

Requirements

• 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.

Our Comprehensive Benefits Package Includes

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

We Understand the Value of a Diverse and Inclusive Workplace

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. Here’s more information. Some states have required notifications. Here’s more information.

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.