<p>Summary</p> <p>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.</p> <p>Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!</p> <p>Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.</p> <p>Description</p> <p>Location</p> <p>This position is onsite, full time (40 hours/week) Monday-Friday 8am-5pm in our Nashville, TN location.</p> <p>What You Will Do:</p> <ul> <li> <p>Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy</p> </li><li> <p>Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools</p> </li><li> <p>Updates letters and documents within the department when necessary</p> </li><li> <p>May gather and prepare documentation for legal inquiries and administrative requests</p> </li></ul> <p>To Qualify for This Position, You Will Need:</p> <ul> <li> <p>Required Education: High school diploma or equivalent</p> </li><li> <p>Required work experience: 2 years in a job-related field</p> </li><li> <p>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</p> </li></ul> <p>We Prefer That You Have The Following:</p> <ul> <li> <p>Critical thinking skills to be able to research and apply Medicare Rules and Regulations to the appeal request.</p> </li><li> <p>Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.</p> </li><li> <p>Intermediate Excel skills.</p> </li><li> <p>Medical claims processing, appeals, billing, or coding experience.</p> </li></ul> <p>What We Can Do for You:</p> <ul> <li> <p>401(k) retirement savings plan with company match.</p> </li><li> <p>Subsidized health plans and free vision coverage.</p> </li><li> <p>Life insurance.</p> </li><li> <p>Paid annual leave - the longer you work here, the more you earn.</p> </li><li> <p>Nine paid holidays.</p> </li><li> <p>On-site cafeterias and fitness centers in major locations.</p> </li><li> <p>Wellness programs and healthy lifestyle premium discount.</p> </li><li> <p>Tuition assistance.</p> </li><li> <p>Service recognition.</p> </li><li> <p>Incentive Plan.</p> </li><li> <p>Merit Plan.</p> </li><li> <p>Continuing education funds for additional certifications and certification renewal.</p> </li></ul> <p>What to Expect Next:</p> <p>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.</p> <p>Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.</p> <p>Equal Employment Opportunity Statement</p> <p>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 individuals with disabilities and protected 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.</p> <p>We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.</p> <p>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.</p> <p>We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. 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