Appeals Specialist

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** Summary
* * Performs non-medical reviews and processes redetermination letters.#
** Description
* *** Location
* * This position is hybrid schedule 3 days onsite reporting at26 Century Blvd Suite ST610

Nashville, TN 37214 and two days remote, this is a full time role (40 hours/week) Monday-Friday.

As an Appeals Specialist, you'll be at the forefront of patient advocacy, reviewing and managing redeterminations and first-level appeals with precision and care. Your daily work involves analyzing comprehensive documentation, identifying missing information, ensuring timely processing, and making decisions that directly impact healthcare outcomes. You'll review cases thoroughly, update records meticulously, and communicate clear decisions through professional correspondence. This is more than data entry—you're the critical checkpoint that ensures fair healthcare decisions are made, and patients receive the answers they deserve.

Work independently on a computer-based role (no phones required) and take pride in knowing your attention to detail and thoroughness makes a tangible difference in people's lives every single day.
** 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.
*
* What You Will 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 Will Need:
*** 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.
** We Prefer That You Have:
*** Experience with Medicare and Appeals
** What We Can Do for You:
*** 401(k) retirement savings plan with company match.
* Subsidized health plans and free vision coverage.
* Life insurance.
* Paid annual leave – the longer you work here, the more you earn.
* Nine paid holidays.
* On-site cafeterias and fitness centers in major locations.
* Wellness programs and healthy lifestyle premium discount.
* Tuition assistance.
* Service recognition.
* Incentive Plan.
* Merit Plan.
* Continuing education funds for additional certifications and certification renewal.
** 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 a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
** 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, 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…