Appeals Specialist

About the role

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. The position requires CMS Security Clearance as it falls within a division subject to Centers for Medicare and Medicaid Services residency requirements. Under the Service Contract Act (SCA), employees cannot opt out of health benefits and will receive supplemental pay until enrolled in health benefits 28 days after hire. This is a full-time (40 hours/week) Monday‑Friday role located onsite at One Century Plaza, Nashville, TN. The position is not eligible for sponsorship now or in the future.

Responsibilities

• 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

• High School Diploma or equivalent.
• 2 years of job‑related experience.
• Demonstrated proficiency in word processing and spreadsheet software; excellent organizational, customer service, and written and verbal communication skills; good judgment; proficiency in spelling, punctuation, and grammar.
• Required software/tools: Microsoft Office.
• Typical office work environment.

Benefits

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