Appeals Specialist (Nashville, TN)

Summary
Join our appeals team to performs non-medical reviews and processes redetermination letters.
Description
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:

• Position is onsite in our Nashville, TN office.
• 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.

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
  

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. Management will be conducting interviews with the most qualified candidates.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
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 minorities, females, disabled individuals and 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 physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail or call 1-800-288-2227, 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.