CGS Administrators, LLC

The role involves providing prompt, accurate, and courteous responses to all customer inquiries via telephone, written, web, or walk-in methods, requiring research and coordination with other departments to resolve issues. Responsibilities also include accurately documenting inquiries, maintaining complaint records, and identifying/reporting suspected fraudulent activities or system errors.

The Appeals Analyst will research complex appeal or retrospective review requests, including pre-pay and post-payment reviews, and provide thorough clinical review or benefit analysis to determine if requested services meet medical necessity guidelines. Responsibilities also include accurately documenting decisions within mandated timeframes and in compliance with applicable regulations or standards.

Logistics CGS –one of BlueCross BlueShield's South Carolina subsidiary companies. This position is full time (40 hours/week) Monday-Friday 8:00-4:30PM CST and will be W@H OR On-site at One Century Plaza, Nashville TN . What You Will Do: Documents the basis of the appeal or retros...

Auditor II responsible for financial, compliance and operational audits