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Results based on filters ( 17 jobs found )

Auditor, Sr Stoploss Claim

CGS Administrators, LLC
Grove City, OH
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86554812 293282365 Internal Reference Number: R1049782 Summary Audit and ...
Details
Summary
About the job:
authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service.Description Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm CST and will be fully remote or hybrid if based near our Dallas office. What You'll Do: Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement...
Location:
Grove City, OH
Job Type:
Full-Time
Permanent
Occupation:
Claims Adjusters, Examiners, and Investigators
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
6
apply
Detailed Job Information

Associate Medical Director DME

CGS Administrators, LLC
Grove City, OH
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85561226_1 293248940 Internal Reference Number: R1048061 Summary Why should ...
Details
Summary
About the job:
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...
Location:
Grove City, OH
Job Type:
Full-Time
Permanent
Occupation:
Compliance Officers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
OhioMeansJobs.com
Certifications / Licenses:
Medical License
Security clearance
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Physical Medicine and Rehabilitation Medical Director

CGS Administrators, LLC
Grove City, OH
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86443015 293246478 Internal Reference Number: R1049672 Summary As member of ...
Details
Summary
About the job:
the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies.Description Logistics: Palmetto GBA, - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or...
Location:
Grove City, OH
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:
OhioMeansJobs.com
Certifications / Licenses:
Board Certified
Medical License
Workkeys
Applied Math
5
Graphic Literacy
6
Workplace Documents
5
apply
Detailed Job Information

Medical Reviewer II (Prior-Auth A/B MAC) - CGS

CGS Administrators, LLC
Grove City, OH
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86416668 293239056 Internal Reference Number: R1049548 Summary Performs ...
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Summary
About the job:
medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.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 roots firmly embedded in...
Location:
Grove City, OH
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
OhioMeansJobs.com
Certifications / Licenses:
Licensed Practical Nurse
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

IT Process Assurance Auditor- 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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Summary
About the job:
assistance, 401(k) United States, Tennessee, Nashville Feb 17, 2026 Summary CGS culture is steeped in how we impact lives within our community and organization. Our culture is invested in six core values: Integrity; Making a Difference; Passion for Excellence; Always Improving; Customer Focused; and Taking Risks. CGS IT is a collaborative, fast-paced environment with a focus on quality. The CGS IT department (GSIT) is responsible for production support, development & research, systems access, security, and project...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Diversityjobs
Certifications / Licenses:
Project Management Institute
Enterprise Project Management
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Medicare Medical Director

CGS Administrators, LLC
Grove City, OH
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85617539 293210977 Internal Reference Number: R1048203 Summary Why should ...
Details
Summary
About the job:
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...
Location:
Grove City, OH
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:
OhioMeansJobs.com
Certifications / Licenses:
Medical License
Board Certified
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Molecular Diagnostics Medicare Medical Director - Palmetto GBA

CGS Administrators, LLC
Grove City, OH
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86292650 293206722 Internal Reference Number: R1048417 Summary As member of ...
Details
Summary
About the job:
the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies.Description Location: This position is full-time (40-hours/week) Monday-Friday-Hourly). This position can be worked remotely. Position Purpose: The Molecular Diagnostics Medicare Medical Director at Palmetto GBA...
Location:
Grove City, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
OhioMeansJobs.com
Certifications / Licenses:
Board Certified
Medical License
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Part A/HHH Appeals Specialist

CGS Administrators LLC
Nashville, TN
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CGS Administrators LLC life insurance, paid holidays, tuition assistance, ...
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About the job:
401(k) United States, Tennessee, Nashville Feb 10, 2026 Summary Performs non-medical reviews and processes redetermination letters. Description 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...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Billing and Posting Clerks
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Diversityjobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Enrollment Analyst- CGS

CGS Administrators LLC
Columbia, SC
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CGS Administrators LLC life insurance, paid time off, 401(k) United States, ...
Details
Summary
About the job:
South Carolina, Columbia Feb 06, 2026 Summary Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. 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 in a typical office environment. You will work an 8-hour shift...
Location:
Columbia, SC
Job Type:
Full-Time
Permanent
Occupation:
Computer User Support Specialists
Career Level / Education:
Some college, no degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Diversityjobs
Certifications / Licenses:
Security clearance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Medical Review Supervisor

CGS Administrators, LLC
Grove City, OH
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86199060 293178534 Internal Reference Number: R1049162 Summary Why should ...
Details
Summary
About the job:
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 landscape, 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...
Location:
Grove City, OH
Job Type:
Full-Time
Permanent
Occupation:
Clinical Nurse Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
OhioMeansJobs.com
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information
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