What are the responsibilities and job description for the Appeals Specialist position at CGS Administrators?
Summary
Performs non-medical reviews and processes redetermination letters.Description
Logistics:
CGS (cgsadmin.com)
– one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at One Century Plaza at 26 Century Blvd. Suite ST610 Nashville, TN 37214.
- SCA Benefit Requirements: BlueCross BlueShield 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.
- Sponsorship: This position is not eligible for sponsorship now or in the future.
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 and documents with 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 Experience:
- Required Experience: 2 years in job related field.
- Required Software and tools: Microsoft Office.
- Required Skills and Abilities: Demonstrated proficiency in word processing and spreadsheet software. Excellent organizational, customer service, and written and verbal communication skills. Good judgement skills. Proficiency in spelling, punctuation, and grammar skills.
We Prefer That You Have The Following:
- Experience in reviewing medical documentation.
Our Comprehensive Benefits Package Includes The Following:
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
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 verify resume specifics and salary requirements.
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 disabilities and 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.com
or 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
more information
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Some states have required notifications. Here's
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