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Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation
Posted 25 days ago
Working at CGS Administrators, LLC Are you looking to be a part of a great professional team working in a fast paced environment where you will be valued and can make a difference? Do you enjoy working with project management processes? Process improvements CMMI L3 to L5? Or maybe utilizing Agile and Waterfall methodologies? How about all of these and more? CGS Administra
Posted 25 days ago
BlueCross BlueShield of South Carolina
- Columbia, SC / Greenville, SC / Charleston, SC
Responsible for the sales, service, and Administrative activities and relationship management to prospective and existing accounts. Customarily and regularly engaged in outside sales. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national l
Posted 26 days ago
BlueCross BlueShield of South Carolina
- Nashville, TN / Columbia, SC / Charleston, SC
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 requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Desc
Posted 27 days ago
Performs non medical reviews and processes redetermination letters. Description Performs non medical reviews and processes redetermination letters ensuring timeliness and accuracy. Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools. Updates letters and documents within the department when necessary. May gather an
Posted 27 days ago
Performs non medical reviews and processes redetermination letters. Description What you will do Perform non medical reviews and process redetermination letters ensuring timeliness and accuracy. Prepare unit reports, analyze and interpret workload, and process issues utilizing various software tools. Update letters and documents within the department when necessary. May g
Posted 29 days ago
Position Purpose We are hiring a Customer Service Advocate II! This role provides prompt, accurate, thorough, and courteous responses to all customer inquiries. This job can be complex and may require research as well as the ability to answer member's questions correctly. The successful candidate for this position will be someone who pays strong attention to detail and is
Posted 1 month ago
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