Developer IV - CGS Administrators, LLC (Nashville, TN)
Nashville, Tennessee, United States · Hybrid
Senior
Summary CGS Administrators, LLC (CGS) is part of BCBSSC™'s Celerian Group of companies and provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, su…
Skills: C#, MS SQL, OnBase, System development lifecycle, Application development
Summary Manages the daily activities of a multi-functional area. Responsible for monitoring productivity, attendance and quality of work produced. Responsible for motivating associates to meet individual and departmental…
Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as neede…
Skills: Customer service, Claims processing, Appeals processing, Verbal communication, Written communication
Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly em…
Summary Manages the daily activities of a multi-functional area. Responsible for monitoring productivity, attendance and quality of work produced. Responsible for motivating associates to meet individual and departmental…
Summary Performs advanced, varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying, compiling records, filing, tabulating, posting information, and distributing m…
Skills: Clerical duties, Data entry, Scanning, Indexing, Imaging
Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. De…
Skills: Claims processing, Appeals processing, Customer service, Verbal communication, Written communication
Summary Extracts and reports enrollment and financial data used to develop competitive rates to achieve financial targets and reach profitability goals. Description Why should you join the BlueCross BlueShield of South C…
Skills: Financial analysis, Reporting, Actuarial modeling, Data extraction, Competitive pricing
Summary Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roo…
Myrtle Beach, South Carolina, United States · On-site
Entry level
Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) …
Myrtle Beach, South Carolina, United States · On-site
Entry level
Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) …
Summary Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and a…
Skills: Customer service, Claims processing, Appeals processing, Verbal communication, Written communication
Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. De…
Skills: Claims processing, Appeals processing, Customer service, Verbal communication, Written communication
Summary Prepares for and performs institutional audits to assess appropriate provider billing and to identify any aberrant billings that may have an impact on reimbursement. Responsible for reviewing all aspects of claim…
Skills: Medical auditing, Clinical nursing, Claim processing, Medical terminology, Anatomy and physiology
Summary We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agen…
Skills: Word processing, Spreadsheet software, Organizational skills, Customer service, Written communication
Summary Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, pr…
Skills: Quality assurance, Auditing, Claims processing, Customer service, Data analysis
Myrtle Beach, South Carolina, United States · On-site
Mid level
Summary Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing su…
Summary Provides education and training support for network providers, staff, suppliers, physicians, beneficiaries, referral agents as necessary. Develops and produces training and educational materials. Description Logi…
Skills: Training materials development, Classroom presentations, Word processing, Spreadsheet software, Customer service
Summary Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or p…
Skills: Utilization review, Case management, Clinical criteria evaluation, Medical necessity assessment, Claims knowledge
Summary Under general supervision, responsible for interpreting, reviewing, and analyzing benefit plan designs. Responsible for creating scope, design and specification documents for programming of benefits from benefit …
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Full-time
bachelor degree, associate degree
Subsidized health plans, Dental coverage, Vision coverage, 401k retirement savings plan, Life insurance, Paid time off
Posted 1d ago
Apply by Aug 13
~40 hrs/week
Responsibilities
Responsible for the analysis, design, programming, and implementation of complex application tasks and projects. You will work closely with customers and team members to ensure technical solutions align with business strategies and architectural standards.
Requirements
Requires a bachelor's degree in a job-related field or equivalent experience, totaling at least 6 years of application development or systems testing experience. Candidates must demonstrate proficiency in programming languages, platform capabilities, and systems analysis.
Full job description
Summary
CGS Administrators, LLC (CGS) is part of BCBSSC™'s Celerian Group of companies and provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 8.7 million Medicare beneficiaries and 103,000 healthcare professionals nationwide.
The CGS IT team consists of ~ 80 people. You will be a part of the Application Development team, which includes 16 developers. We are a Microsoft shop, and our core technologies include OnBase, C#, and MS SQL. Developers in our department are involved in the complete System Development Lifecycle. We build and support applications for our internal users as well as our external customers (Medicare providers and suppliers).
Description
Logistics: CGS –one of BlueCross BlueShield's South Carolina subsidiary companies.
Sponsorship: This position is not eligible for sponsorship now or in the future.
Fast paced, multi-platformed environment which may require action and response 24X7 to support the technical business needs of the customer.
Position Purpose:
Responsible for analysis, design, programming, and implementation of complex applications tasks and projects. Devise feasible, logical procedures to resolve business problems through the use of computer resources. Formulate scope and objectives through research to develop or modify complex systems. Review detailed specifications and recommend modifications. Design, code, test and debug complex application programs.
What you’ll do:
Produce deliverables related to the assigned project. Perform analysis, design, programming, and implementation of systems and procedures to solve complex business or scientific problems. Evaluate interrelationships in immediate programming area to determine how changes in one program will affect another related area. Apply conversions and enhancements to business systems. May lead or provide expertise on assigned projects.
Work closely with customers, business analysts, and team members to understand business requirements that drive the analysis and design of quality technical solutions. Ensure solutions are aligned with business and IT strategies and comply with the organization’s architectural standards. Assist in post-implementation support and system enhancements.
Test modified programs, create necessary test files and data, verify logic, debug, and write relevant documentation.
Design and develop IT systems. Devise new sources of data and develop new approaches and techniques. Involved in the full systems life cycle and is responsible for designing, coding, testing, implementing, maintaining and supporting complex application software that is delivered on time and within budget.
Provide guidance to lower-level programmers/analysts. Act as an internal consultant by providing technical guidance on complex projects. Determine and resolve problems with other systems analysts, programmers, and systems users.
Test designed programs, verify logic, perform any necessary "debugging," and write the documentation.
To Qualify for This Position, You’ll Need:
Required Education:
Bachelor's in a job related field
Degree Equivalency:
Associates degree plus an extra 2 years job-related experience for a total of 8 years of required work experience (see "required work experience")
OR
10 total years required work experience
Required Work Experience:
6 years-of application development, systems testing or other job-related experience.
Required Skills and Abilities:
Comprehensive understanding of applications/development, quality assurance and integration methodologies, concepts and facilities in a mainframe, midrange, web, and/or PC/LAN environment.
Demonstrates a high level of technical proficiency in the areas of programming languages, platform capabilities, and methods of systems analysis and program design.
Excellent analysis, decision-making, and problem solving skills.
Demonstrates logical abstract thinking and assimilating/adhering to project goals and deadlines.
Ability to communicate effectively verbally and in writing.
Able to work well under pressure and as part of a team.
Strong knowledge of interpersonal skills/team building.
Familiar with project management concepts.
Ability to assess requirements, alternatives, and risks/benefits for low- to high-impact projects.
Pays attention to detail.
Ability to establish and maintain effective working relationships with employees, clients, vendors etc. In-depth understanding of organizational functions, behavior, and inter-relationships.
Required Software and Other Tools:
Comprehensive knowledge of relevant operating systems, programming languages, and development tools and their usage in the company.
We Prefer That You Have:
.NET Framework and C#: Developing proficiency in.NET Framework for developing robust applications.
MS SQL Database: Awareness and basic knowledge of SQL.
OnBase experience.
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
Our comprehensive benefits package includes:
Subsidized health plans, dental and vision coverage
401K retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
Nine paid holidays
On-site cafeterias and fitness centers in major locations
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee Assistance
Discounts to movies, theaters, zoos, theme parks and more
What to Expect Next:
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 our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.
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 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.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
Related keywords
C#MS SQLOnBaseMedicareHealthcareApplication DevelopmentSystem Development LifecycleProgrammingSystems AnalysisQuality AssuranceIntegrationMainframeWeb DevelopmentPC/LANProject ManagementTechnical Documentation
South Carolina’s largest and oldest health insurance company
Industry
Insurance
Company size
10,001+ employees
Founded
1946
Headquarters
Columbia, South Carolina
LinkedIn followers
52,584
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!
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
We are an Equal Opportunity Employer. We will consider all qualified applicants for employment 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.
Offices: I-20 E at Alpine Road, Columbia, South Carolina 29219, US
Health Care InsuranceInformation TechnologyData ProcessingHealth Care Benefitshealth insurancehealth carehealth insurance carrierBlueCross jobsCorporate philanthropyinsurance
South Carolina’s largest and oldest health insurance company
Industry
Insurance
Company size
10,001+ employees
Founded
1946
Headquarters
Columbia, South Carolina
LinkedIn followers
52,584
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!
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
We are an Equal Opportunity Employer. We will consider all qualified applicants for employment 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.
Offices: I-20 E at Alpine Road, Columbia, South Carolina 29219, US
Health Care InsuranceInformation TechnologyData ProcessingHealth Care Benefitshealth insurancehealth carehealth insurance carrierBlueCross jobsCorporate philanthropyinsurance