Appeals Specialist - (CGS Admin)

Why should you join the BlueCross BlueShield of South Carolina family of companies? For more than seven decades, we’ve 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, operate one of the most sophisticated data processing centers in the Southeast, and 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, and if you are dedicated to the same philosophy, consider joining our team!

This open position is within CGS Administrators, a subsidiary of BlueCross BlueShield of South Carolina. 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.

About the role

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.

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.

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

Required Education: High School Diploma or equivalent

Required Work Experience: 2 years in a job-related field

Skills

• 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
• Proficiency with Microsoft Office

Preferred Skills and Experience:

• Experience in medical claims processing, appeals, or coding
• Medicare Part B experience
• 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

Benefits

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