Appeals Specialist (CGS Admin)

Summary We are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South Carolina. In this role as Appeals Specialist, you will be required to perform non‑medical reviews and process redetermination letters. Why Join Us BlueCross BlueShield of South Carolina has been part of the national landscape for more than seven decades and is the largest insurance company in South Carolina, with deep roots in the local community. We are a leading administrator of government contracts, operate a sophisticated data processing center, and offer a diverse range of subsidiary companies. Employees deliver outstanding service to our customers. Logistics Location: This position is onsite with work hours starting between 6:00 AM and 7:30 AM Central Time. You will work an 8‑hour shift schedule and may occasionally work overtime. The role is fully remote or can be performed onsite at 26 Century Blvd, Suite ST610 Nashville, TN 37214 United States of America. Benefits eligibility: Employees must enroll in health insurance under the Service Contract Act; supplemental pay is 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 with timeliness and accuracy. Prepare unit reports, analyze and interpret workload, and resolve 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 job‑related field. Required Skills and Abilities: Proficiency in word processing and spreadsheet software; excellent organizational, customer service, written and verbal communication skills; good judgment; mastery of spelling, punctuation, and grammar. Required Software: Microsoft Office. Preferred Qualifications Experience in medical claims processing, appeals, or coding. Experience with Medicare Part B. Strong computer proficiency with multiple systems and dual‑screen work. Intermediate‑level Excel skills. Experience creating letters and documents by reviewing appeals and extracting information accurately; update departmental documents as needed. Benefits Package We offer a comprehensive benefits program including: 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 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 opportunities for individuals with disabilities and protected veterans. We provide equal employment opportunities in all phases of the hiring process and comply with all applicable federal, state, and local laws and regulations. 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, as long as 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 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. #J-18808-Ljbffr CGS Administrators LLC