[Hiring] Appeals Specialist @CGS Administrators, LLC

Role Description

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

Logistics:

• CGS (cgsadmin.com) – one of BlueCross BlueShield's South Carolina subsidiary companies.
• 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.
• 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 letters and documents within the department when necessary.
• May gather and prepare documentation for legal inquiries and administrative requests.

Qualifications

• High School Diploma or equivalent.
• 2 years job related field experience.
• 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.
• Microsoft Office proficiency.

Requirements

• 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.

Benefits

• 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.