Summary
Responsible for maintaining the proper flow of the request for appeals.
Description
Logistics: Palmetto GBA - a BlueCross BlueShield of South Carolina subsidiary company.Please submit your application along with an updated resume for consideration.
- This position requires CMS Security Clearance as it falls within a division subject to Centers for Medicare and Medicaid Services residency requirements.
- Compensation Grade 130 — candidates currently in a lower grade are encouraged to apply as this may represent a promotional opportunity.
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.
About This OpportunityPalmetto GBA is seeking a detail-oriented and organized Coordinator, Appeals to join our appeals processing team. In this role, you will serve as the frontline support for all incoming appeal requests — reviewing, triaging, and routing cases to ensure timely and accurate processing in accordance with CMS guidelines. If you thrive in a structured, fast-paced environment and take pride in accuracy and organization, we'd love to hear from you!What You Will Do:- Research requests, enter appropriate data to identify case specifics, and build appeals cases in the system.
- Log requests to the appropriate functional area, generate letters, assemble files, order records, and obtain additional information as directed.
- Ensure quality control of all appeals on the appeals system, pend documents to be saved electronically, and prepare case files for review and/or further routing.
- High School Diploma or equivalent
- 1 year of administrative support/clerical or job-related experience
- Demonstrated proficiency in word processing and spreadsheet software
- Effective organizational and customer service skills
- Good judgment skills
- Proficiency in spelling, punctuation, and grammar
- Demonstrated written and verbal communication skills
- Microsoft Office proficiency
- 3 years of experience in claims, customer service, or healthcare program management
- Ability to persuade, negotiate, or influence
- Knowledge of Microsoft Access or other database software
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 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.
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.
If you need special assistance or an accommodation while seeking employment, please email [email protected] 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.
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Skills Required
- High School Diploma or equivalent
- 1 year of administrative support/clerical experience
- Demonstrated proficiency in word processing and spreadsheet software
- Effective organizational and customer service skills
- Good judgment skills
- Proficiency in spelling, punctuation, and grammar
- Demonstrated written and verbal communication skills
- Microsoft Office proficiency
What We Do
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now!
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