Specialist, Appeals

External

Ourhrconnect · Nashville, TN

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About the role

Performs non-medical reviews and processes redetermination letters. Logistics: CGS -one of BlueCross BlueShield's South Carolina subsidiary companies. Location : This position is hybrid schedule 3 days onsite reporting at 26 Century Blvd Suite ST610 Nashville, TN 37214 and two days remote, this is a full-time role (40 hours/week) Monday-Friday. As an Appeals Specialist, you'll be at the forefront of patient advocacy, reviewing and managing redeterminations and first-level appeals with precision and care. Your daily work involves analyzing comprehensive documentation, identifying missing information, ensuring timely processing, and making decisions that directly impact healthcare outcomes. You'll review cases thoroughly, update records meticulously, and communicate clear decisions through professional correspondence. This is more than data entry-you're the critical checkpoint that ensures fair healthcare decisions are made, and patients receive the answers they deserve. Work independently on a computer-based role (no phones required) and take pride in knowing your attention to detail and thoroughness makes a tangible difference in people's lives every single day. 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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Responsibilities

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

To Qualify for This Position, You Will Need:

Required Education : High school diploma or equivalent

Required work experience: 2 years in a job-related field

Required Skills and abilities : Demonstrated proficiency in word processing and spreadsheet software, excellent organizational, customer-service, and written and oral communications skills, good judgment, proficiency in spelling, punctuation and grammar, Microsoft Office skills

What We Can Do for You:

401(k) retirement savings plan with company match.

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 healthy lifestyle premium discount.

Tuition assistance.

Service recognition.

Incentive Plan.

Merit Plan.

Continuing education funds for additional certifications and certification renewal.

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 a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

Equal Employment Opportunity Statement

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 .

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

Specialist, Appeals

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