Appeals Specialist

Summary We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years.

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description Position

Purpose:

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

Logistics: CGS - one of Blue Cross Blue Shield'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:
Blue Cross Blue Shield 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 position is full-time (40 hours/week) Monday-Friday located onsite at 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 Blue Cross  Blue Shield 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,…