Part A/HHH Appeals Specialist

CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide.

We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Logistics:

Logistics: CGS -one of BlueCross BlueShield's South Carolina subsidiary companies.

• Position is onsite at Century Blvd, Ste ST610, Nashville, TN 37214-3685

• Work hours: Eight-hour shift starting between 6:00 am and 9:00 am Monday through Friday allowing you to work the schedule that best fits your needs after training.

What you will do:

• Perform non-medical reviews and process redetermination letters ensuring timeliness and accuracy.

• Prepare unit reports, analyze and interpret workload, and process issues utilizing various software tools.

• Update letters and documents within the department when necessary.

• May gather and prepare documentation for legal inquiries and administrative requests.

What you need to qualify:

• High School Diploma or equivalent

• Two years job related field (insurance claims, medical office, or similar).

• 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.

What we prefer you have:

• Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.

• Intermediate Excel skills.

• Medical claims processing, appeals, billing, or coding experience.

What We Can Do for You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match & annual enhancement

• 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 a healthy lifestyle premium discount

• Sports membership program

• Tuition assistance

• Service Recognition

Equal Employment Opportunity Statement

BlueCross BlueShield 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 disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

Some states have required notifications. Here's more information.