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Senior Medical Director (Palmetto GBA)

CGS Administrators, LLC
Grove City, OH
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84495309 292544306 Internal Reference Number: R1045875 Summary Position ...
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Purpose As a member of the leadership team, you will oversee and direct the synthesis of data and clinical knowledge in the development of information that is used to inform the detection, correction and prevention of claims payment errors. You will lead a Medical Review team in the development and implementation of an efficient and effective medical review strategy which includes the integration of policy and education, that optimizes critical medical review cycle times. In this role you will also serve as the Medical...
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Applied Math
5
Graphic Literacy
5
Workplace Documents
5
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Medical Affairs Coordinator

CGS Administrators, LLC
Grove City, OH
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84845683 292544308 Internal Reference Number: R1046743 Summary Ensures that ...
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the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. The error rate is a factor in awarding and renewing Medicare/other contracts.Description Location This role is remote, full time M-F 8am-5pm. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S....
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Applied Math
5
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5
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5
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Technician, Data Preparation Senior

CGS Administrators LLC
Nashville, TN
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CGS Administrators LLC life insurance, paid time off, 401(k) United States, ...
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Tennessee, Nashville 2 Vantage Way ( Show on map ) Sep 08, 2025 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 mail. Applies knowledge of department policies and procedures, and utilizes a general understanding of other departments' functions to resolve most issues. Maintains records, prepares forms, verifies information and resolves routine...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Office Clerks, General
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
From:
Diversityjobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
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System Support Administrator- CGS Administrators, LLC

CGS Administrators LLC
Nashville, TN
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CGS Administrators LLC life insurance, paid time off, paid holidays, tuition ...
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assistance, 401(k) United States, Tennessee, Nashville 2 Vantage Way ( Show on map ) Sep 05, 2025 Summary Working at CGS Administrators CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide. The CGS IT team consists of ~ 115 people. You will be a part of the Production Support team,...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Network and Computer Systems Administrators
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Diversityjobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Auditor II (Medicare Cost Reporting)

CGS Administrators, LLC
Grove City, OH
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84675378 292488602 Internal Reference Number: R1044120 Summary Why should ...
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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 embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary...
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
6
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Application Development Manager-CGS Administrators, LLC (Nashville, TN)

CGS Administrators LLC
Nashville, TN
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CGS Administrators LLC life insurance, paid time off, paid holidays, tuition ...
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assistance, 401(k) United States, Tennessee, Nashville 2 Vantage Way ( Show on map ) Aug 26, 2025 Summary Working at CGS Administrators CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide. We deliver outstanding service to our customers. If you are dedicated to the same philosophy,...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Information Technology Project Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Diversityjobs
Certifications / Licenses:
Cadastral Mapping Specialist
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Manager, Medical Review (RN Manager)

CGS Administrators LLC
Nashville, TN
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CGS Administrators LLC life insurance, paid time off, 401(k) United States, ...
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Tennessee, Nashville 2 Vantage Way ( Show on map ) Aug 22, 2025 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. Identifies and implements process improvement opportunities. 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...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Diversityjobs
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Lead Claims Processor

CGS Administrators, LLC
Darbydale, OH
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84535522 292321866 Internal Reference Number: R1046338 Summary Functions as ...
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About the job:
the team lead and subject-matter expert for a claims area. Responsible for creating reports, distributing workload and training new employees.Description Logistics: CGS (cgsadmin.com),- one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:00pm CST and will be fully remote. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the...
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From:
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Certifications / Licenses:
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
3
apply
Detailed Job Information

Registered Nurse Senior Medical Reviewer (Medicare Part B Appeals) - CGS

CGS Administrators, LLC
Grove City, OH
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84495308 292300460 Internal Reference Number: R1045305 Summary We are ...
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About the job:
currently hiring for a Registered Nurse Senior Medical Reviewer to join CGS, a Celerian Group Company and subsidiary of BlueCross BlueShield of South Carolina. The team the position will work on handles Medicare Part B DME claims. In this role you will Act as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training to staff. You will also ensure appropriate levels of healthcare...
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From:
OhioMeansJobs.com
Certifications / Licenses:
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

Lead Claims Processor

CGS Administrators, LLC
Darbydale, OH
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84480610 292291566 Internal Reference Number: R1046184 Summary Functions as ...
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About the job:
the team lead and subject-matter expert for a claims area. Responsible for creating reports, distributing workload and training new employees.Description Logistics: Palmetto GBA- one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm. This role is located on-site at 17 Technology Circle, Columbia, SC 29203. This role has the potential to transition to remote work, based on performance and business needs. SCA Benefit...
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Occupation:
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Salary:
From:
OhioMeansJobs.com
Certifications / Licenses:
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
3
apply
Detailed Job Information
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