Appeals Specialist (CGS Admin

Appeals Specialist

We are currently hiring for an Appeals Specialist to join Blue Cross Blue Shield of South Carolina. In this role as Appeals Specialist, you will be required to perform non-medical reviews and process redetermination letters.

Why should you join the Blue Cross Blue Shield of South Carolina family of companies? For more than seven decades we have been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

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

Logistics: CGS () – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

Location:

This position is onsite with work hours starting between 6:00 AM and 7:30 AM Central Time. You will work an 8-hour shift schedule. It may be necessary, given the business need to work occasional overtime. This role is fully remote or can sit onsite at 26 Century Blvd, Suite ST610 Nashville, TN 37214 United States of America.

• 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). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage.
  
  Your coverage begins on the first day of the month following 28 days of full-time employment.

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 letter's 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.

We Prefer That You Have the Following:

• Experience in medical claims processing, appeals, or coding strongly preferred
• Medicare Part B experience preferred
• Strong computer proficiency, with the ability to navigate multiple systems and work across dual screens efficiently
• Intermediate-level Excel skills
• Experience creating letters and documents by reviewing appeals and extracting information with a high degree of accuracy; updates departmental documents as needed.

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.

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…