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Jobs at CGS Administrators, LLC (Now Hiring) — 5 open

CGS Administrators, LLC logoCGS Administrators, LLC

Customer Service Advocate I

Nashville, Tennessee, United States · Remote OK

Mid level

Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description Location: This position is a full-time remote position (40-hour…

Skills: Verbal Communication, Written Communication, Human Relations, Organizational Skills, Stress Management

CGS Administrators, LLC logoCGS Administrators, LLC

Assistant, Qualified Independent Contractor

Nashville, Tennessee, United States · Hybrid

Entry level

Summary Provides all redetermination case file information within the specified time requirement while maintaining accuracy and departmental standards. Suspends claims in applicable claim system and tracks all data. Desc…

Skills: Organizational Skills, Decision Making, Customer Service, Detail Oriented, Analytical Thinking

CGS Administrators, LLC logoCGS Administrators, LLC

RN Appeals Analyst

Nashville, Tennessee, United States · Remote Solely

Mid level

Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the req…

Skills: Clinical Review, Benefit Analysis, Research Skills, Decision Making, Confidentiality

CGS Administrators, LLC logoCGS Administrators, LLC

Manager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH)

Nashville, Tennessee, United States · Hybrid

Senior

Summary Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identi…

Skills: Medical Review, Utilization Review, Clinical Supervision, Medicare Policy Knowledge, Process Improvement

CGS Administrators, LLC logoCGS Administrators, LLC

RN Appeals Analyst Medicare Part B - CGS

Nashville, Tennessee, United States · Remote OK

Mid level

Summary We are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South Carolina. In this role as Appeals Analyst, you will research the substance of complex appeal or retrospective review requests i…

Skills: Clinical Review, Benefit Analysis, Medical Necessity Guidelines, Utilization Review, Case Management

CGS Administrators, LLC logo

Customer Service Advocate I

CGS Administrators, LLC

Nashville, Tennessee, United States • Remote OK

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Mid level

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  • Full-time
  • high school, associate degree
  • Subsidized Health Plans, Dental Coverage, Vision Coverage, 401k Retirement Savings Plan With Company Match, Life Insurance, Paid Time Off (PTO)
  • Posted 2d ago
  • Apply by Jun 30
  • ~40 hrs/week
  • Remote in Nashville, Tennessee, United States

Responsibilities

Provide prompt and accurate responses to customer inquiries via telephone, web, and written communication. Research and resolve customer problems while coordinating with other departments and providing feedback to management.

Requirements

Requires a high school diploma and strong communication and organizational skills. Preference is given to candidates with an associate degree and two years of customer service or call center experience.

Full job description


Summary
 

Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries.


Description
 

Location: This position is a full-time remote position (40-hours/week). The work hours are Monday-Friday 7:30AM-4PM CT.

What You’ll Do:

  • Ensure effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk-in inquiries. Accurately documents inquiries.

  • Initiate or process adjustments or performs other research as needed to resolve inquiries. Coordinates with other departments to resolve problems. Responds to, research and/or assists with priority inquiries and special projects as required by management.

  • Provide feedback to management regarding customer problems, questions, and needs. Maintains accurate records on complaints and/or other customer comments and makes recommendations for changes to management. Follows through on complaints until resolved or reports to management as needed.

  • Maintain basic knowledge of quality work instructions and company policies. Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations. Maintains all departmental productivity, quality, and timeliness standards.

  • Identify and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

To Qualify For This Position, You'll Need The Following:

  • Required Education: High School Diploma or equivalent

  • Required Skills and Abilities: Excellent verbal and written communication skills. Strong human relations and organizational skills. Ability to handle high stress situations. Good judgment skills. Strong customer service skills. Ability to learn and operate multiple computer systems effectively and efficiently.

  • Required Software and Other Tools: Basic computer operating skills. Standard office equipment.

We Prefer You Have:

  • Preferred Education: Associate degree

  • Preferred Work Experience: 2 years-of customer service or call center experience.

  • Preferred Software and Other Tools: Knowledge of word processing, spreadsheet, and database software.

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

  • Subsidized health plans, dental and vision coverage

  • 401k 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

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 the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.

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.

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.

Some states have required notifications. Here's more information. 

Related keywords

Customer ServiceCall CenterMedicareMedicaidWord ProcessingSpreadsheetsDatabase SoftwareFraud DetectionProcess ImprovementRemote WorkCustomer Relations

About CGS Administrators, LLC

LinkedInVisit site

CGS Administrators is a premier healthcare administrator with more than 50 years of industry leadership.

Industry
Government Administration
Company size
501-1,000 employees
Headquarters
Nashville, TN
LinkedIn followers
5,219

Headquartered in Nashville, Tennessee, CGS Administrators, LLC (CGS) is a premier healthcare administrator with over 55 years of industry leadership. We are a proud part of the Celerian Group, a BlueCross BlueShield of South Carolina consortium of companies that help government and private healthcare plans navigate the complexities of a changing marketplace. Our dynamic staff performs all phases of healthcare administration, from claims processing and appeals management to call centers and fraud prevention. We prioritize customer satisfaction through a culture of continuous improvement, consistent performance, and excellent innovation. We also believe in giving back to the community by supporting nonprofits like Second Harvest, United Way, March of Dimes, and FiftyForward. Current CGS contracts for the Centers for Medicaid & Medicare Services (CMS) include Jurisdiction 15 A/B/HHH Medicare Administrative Contractor (MAC) and Jurisdictions B and C Durable Medical Equipment (DME) MACs. Our core experience as a MAC for multiple jurisdictions brings added value to these programs. Interested? Join our team! Click the “Jobs” tab to view current openings.

Offices: 26 Century Blvd, Ste ST610, Nashville, TN 37214-3685, US · 3021 Montvale Drive, Suite C, Springfield, IL 62704, US

Healthcare Administrative ServicesClaims ProcessingHealthcare Fraud and Abuse Preventionand Business Process OutsourcingHealth CareGovernment
View all jobs at CGS Administrators, LLC

About CGS Administrators, LLC

LinkedInVisit site

CGS Administrators is a premier healthcare administrator with more than 50 years of industry leadership.

Industry
Government Administration
Company size
501-1,000 employees
Headquarters
Nashville, TN
LinkedIn followers
5,219

Headquartered in Nashville, Tennessee, CGS Administrators, LLC (CGS) is a premier healthcare administrator with over 55 years of industry leadership. We are a proud part of the Celerian Group, a BlueCross BlueShield of South Carolina consortium of companies that help government and private healthcare plans navigate the complexities of a changing marketplace. Our dynamic staff performs all phases of healthcare administration, from claims processing and appeals management to call centers and fraud prevention. We prioritize customer satisfaction through a culture of continuous improvement, consistent performance, and excellent innovation. We also believe in giving back to the community by supporting nonprofits like Second Harvest, United Way, March of Dimes, and FiftyForward. Current CGS contracts for the Centers for Medicaid & Medicare Services (CMS) include Jurisdiction 15 A/B/HHH Medicare Administrative Contractor (MAC) and Jurisdictions B and C Durable Medical Equipment (DME) MACs. Our core experience as a MAC for multiple jurisdictions brings added value to these programs. Interested? Join our team! Click the “Jobs” tab to view current openings.

Offices: 26 Century Blvd, Ste ST610, Nashville, TN 37214-3685, US · 3021 Montvale Drive, Suite C, Springfield, IL 62704, US

Healthcare Administrative ServicesClaims ProcessingHealthcare Fraud and Abuse Preventionand Business Process OutsourcingHealth CareGovernment
View all jobs at CGS Administrators, LLC

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