Specialist, Appeals

CGS Administrators LLC; Nashville (TN); Hybrid; USD 50,000 - 65,000; Full time

Benefits offered by this job

Subsidized health plans, dental and/or

Job summary

CGS Administrators LLC seeks an Appeals Specialist to perform non-medical reviews and process redetermination letters within a structured health benefits environment. The role emphasizes timeliness, accuracy, and clear communications with claimants and internal teams.

Hybrid work is available after training; normal hours are 8 to 5 CT, Monday–Friday, with primary location in Nashville, TN. Requires CMS clearance and strong Microsoft Office proficiency.

Qualifications

• High School Diploma or equivalent required.
• Demonstrated proficiency with word processing and spreadsheets.
• Excellent written and verbal communication, organization and judgment.

Responsibilities

• Performs non-medical reviews and processes redetermination letters with timeliness and accuracy.
• Prepares unit reports, analyzes workload, and uses software tools to resolve issues.
• Updates letters and documents within the department when needed.
• May gather and prepare documentation for legal inquiries and requests.

Skills

Word processing

Spreadsheets

Communication skills

Organization

Customer service

Grammar punctuation

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

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

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.

To Qualify For This Position, You'll Need The Following

• 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 The Following

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

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 disabilitiesand 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 moreinformation.

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