Appeals Specialist (CGS Admin)

Internal Reference Number: R1050717 We are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South Carolina. In this role, the candidate will perform non‑medical reviews and process redetermination letters. BlueCross BlueShield of South Carolina is a prominent insurer with deep community roots and extensive experience in administering government contracts. Logistics Logistics: CGS (cgsadmin.com) – one of BlueCross BlueShield’s South Carolina subsidiary companies. Location & Hours Location: This position may be fully remote or based at 26 Century Blvd, Suite ST610, Nashville, TN 37214, USA. Work hours start between 6:00 AM and 7:30 AM Central Time on an 8‑hour shift schedule. Occasional overtime may be required. SCA Benefit Requirements As a Service Contract Act employee, you are required to enroll in health insurance, even if you already have coverage. Supplemental pay will be provided until enrollment is complete. Coverage begins on the first day of the month following 28 days of full‑time employment. What You’ll Do Perform non‑medical reviews and process redetermination letters, ensuring timeliness and accuracy. Prepare unit reports, analyze and interpret workload, and process issues using various software tools. Update letters and documents within the department when necessary. Gather and prepare documentation for legal inquiries and administrative requests. Qualifications Required Education: High School Diploma or equivalent. Required Work Experience: 2 years in a related field. Required Skills and Abilities: Proficiency in word processing and spreadsheet software; excellent organizational, customer service, written and verbal communication, and judgment skills; strong spelling, punctuation, and grammar abilities. Required Software and Tools: Microsoft Office. Preferred Qualifications Experience in medical claims processing, appeals, or coding. Medicare Part B experience. Strong computer proficiency; ability to navigate multiple systems and work across dual screens efficiently. Intermediate‑level Excel skills. Experience creating letters and documents by reviewing appeals and extracting information with a high degree of accuracy; updating departmental documents as needed. Benefits Subsidized health plans, dental and vision coverage. 401(k) 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. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and its 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. As a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. We provide equal opportunities in all phases of the employment process and comply with applicable federal, state and local laws and regulations. Accommodations We are committed to providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided those accommodations do not impose undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email View email address on click.appcast.io or call View phone number on click.appcast.io with the nature of your request. We will determine your request on a case‑by‑case basis. #J-18808-Ljbffr BlueCross BlueShield of South Carolina