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Full Time Bluecross Blueshield Jobs (NOW HIRING)

A-Perfect Climate

HVAC Sales Consultant

Addison, IL · On-site

$30K - $50K/yr

... Type: Full-Time About Us: Established in 1987, A Perfect Climate Inc. (APC) has been a leading ... of the cost through BlueCross/BlueShield. * Dental insurance coverage, with the employer ...

A-Perfect Climate

HVAC Comfort Advisor

Addison, IL · On-site

$70K - $150K/yr

... Type: Full-Time About Us: Established in 1987, A Perfect Climate Inc. (APC) has been a leading ... of the cost through BlueCross/BlueShield. * Dental insurance coverage, with the employer ...

Ourhrconnect

Technician, Accounting II-CGS

Nashville, TN · On-site

$40K - $53K/yr

Logistics: * - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: * This is a full-time position (40-hours/week) working an 8hr shift Monday-Friday within the hours of 6 ...

Ourhrconnect

Technician, Accounting II-CGS

Nashville, TN

$40K - $53K/yr

Logistics: * - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: * This is a full-time position (40-hours/week) working an 8hr shift Monday-Friday within the hours of 6 ...

Ourhrconnect

Provider File Specialist I

Columbia, SC · On-site

BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will ...

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Coordinator, Medical Affairs

BlueCross BlueShield of South Carolina

Nashville, TN • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

BlueCross BlueShield of South Carolina rating

7.5

Company rating: 7.5 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

217th of 303 rated insurance

Job description

Summary
We are currently hiring a Medical Affairs Coordinator at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years.
Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
Description
Position Purpose: This role serves as the primary point of contact for all activities related to the Administrative Law Judge (ALJ) program. This includes medical record review, policy analysis and interpretation, preparing other ALJ team members for hearings, writing position papers for submission to the court, and testifying on behalf of CGS and the Medicare Program.
Logistics: CGS -one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40 hours/week) Monday-Friday 8:00 AM-5:00 PM CST and will be hybrid or remote. The office is located at One Century Plaza, Nashville, TN.
  • Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
  • 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). As a Service Contract Act (SCA)employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.
  • Sponsorship: This position is not eligible for sponsorship now or in the future.

What You Will Do:
  • Provides clinical expertise, research, and judgment to develop Local Coverage Determinations (LCDS) under the direction of medical director. Maintains LCDS once developed.
  • Educates providers and internal customers on LCDS. Communicates with other interdepartmental staff in appropriate coding and reimbursement guidelines to ensure coordination and compliance.
  • Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability

To Qualify for This Position, You Will Need The Following:
  • Required Education: Bachelor's in a job related field
  • Degree Equivalency: Associate's degree in Nursing with an active RN license.
  • Required Work Experience: 5 years clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
  • Required Skills and Abilities: Knowledge of managed care or medical claims payment policy issues. Working knowledge of word processing, spreadsheet software. Excellent verbal and written communication skills. Excellent customer service, organizational, presentation, analytical or critical thinking skills. Ability to persuade, negotiate, or influence others. Ability to handle confidential or sensitive information with discretion. Sound clinical review judgement. Independent thinking and strong organizational skills.
  • Required Software and Tools: Microsoft Office.
  • Required License and Certificate: An active, unrestricted RN license from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). For Division 33, Certified Genetic Counselor will be considered in lieu of RN License.

What We Prefer You Have The Following:
  • Preferred Education: Bachelor's degree- Nursing.
  • Preferred Work Experience: 7 years-clinical experience in medical insurance, managed care, case management, or claims management, or a combination of these areas.
  • Preferred Skills and Abilities: Working knowledge of database software. Knowledge of government/healthcare programs and contracts laws, regulations. Knowledge of government/healthcare programs and regulations, coding, and approval practices. Knowledge of corporate administrative/medical policy for all lines of business. Knowledge of guidelines, benefits, and coverage for all lines of business.
  • Preferred Software and Tools: Working knowledge of Microsoft Access or other database software, DB2 and Easytrieve.
  • Preferred Licenses and Certificates: HIAA, CCM, MPH, MHA certifications.
  • Work Environment: Typical office environment. Some travel required.

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
  • Continuing education funds for additional certifications and certification renewal.

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 a 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.
Salary Range:
Range Minimum
$55,251.00
Range Midpoint
$80,371.50
Range Maximum
$105,492.00
Pay Transparency Statement:
Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
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.

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About BlueCross BlueShield of South Carolina

Sourced by ZipRecruiter

BlueCross BlueShield of South Carolina, headquartered in Columbia, SC, USA, is a major stakeholder in the country's healthcare sector. The company holds the distinction of being one of the largest health insurers in South Carolina. As an independent licensee of the BlueCross BlueShield Association, it offers an extensive range of health insurance products and services, focusing not just on medical coverage, but also on dental, vision, and other supplementary health options. The company was founded in 1946 and has since established itself as a trusted leader in the health sector, committed to affordability, accessibility, and customer service. Their mission is to ensure that all South Carolinians have access to high-quality healthcare and exemplify the core values of accountability, transparency, and commitment to customer satisfaction.

Industry

Insurance services

Company size

10,000+ Employees

Headquarters location

Columbia, SC, US

Year founded

1946

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