Appeals Specialist - Cgs Administrators

Summary

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

• Work hours during training: 7:30 am to 4:00 pm CT Monday through Friday
• Work hours following training: You can start your eight-hour shift between the hours of 5:00 am and 9:00 am CT.

What You Will Do

• May gather and prepare documentation for legal inquiries and administrative requests.
• Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
• Updates letters and documents within the department when necessary.
• Prepares unit reports, analyzes, and interprets workload, and processes issues utilizing various software tools.

What You Need To Qualify

• Two years of job experience in a related field.
• High School Diploma or equivalent.

What We Prefer You Have

• Medical claims processing, appeals, billing, or coding experience.
• Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.
• Intermediate Excel skills.

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 access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our Comprehensive Benefits Package Includes

• On-site cafeterias and fitness centers in major locations
• Life insurance
• Paid annual leave — the longer you work here, the more you earn
• Fantastic health plans and free vision coverage
• Nine paid holidays
• Tuition assistance
• 401(k) retirement savings plan with company match
• Service recognition
• Wellness programs and a healthy lifestyle premium discount

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.

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 [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.