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Results based on filters ( 23 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 ...
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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

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 Mar 12, 2026 Summary Performs non-medical reviews and processes redetermination letters. Description Location : This position is hybrid schedule 3 days onsite reporting at 26 Century Blvd Suite ST610Nashville, TN 37214 and two days remote, this is a full time role (40 hours/week) Monday-Friday. As an Appeals Specialist, you'll be at the forefront of patient advocacy, reviewing and managing redeterminations and first-level appeals with precision and care. Your daily work...
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Compliance Officers
Career Level / Education:
Bachelor's degree
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

CUSTOMER SERVICE ADVOCATE I

CGS Administrators, LLC
Located in Ohio
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Summary Provides prompt, accurate, thorough and courteous responses to all ...
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Summary
About the job:
customer inquiries. Performs research as needed to resolve inquiries. Description Logistics: CGS - One of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40 hours/week) Monday-Friday. This is a remote position with training from 7:30am-4pm CST for six weeks. Normal work hours will be from 8:30-5pm CST What You’ll Do: - Ensure effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk-in inquiries. Accurately...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
From:
Himalayas
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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 ...
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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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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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Summary CGS culture is steeped in how we impact lives within our community ...
Details
Summary
About the job:
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 management office (PMO) activities. The PMO is responsible for providing resources to support and implement the software development life cycle (SDLC)...
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:
Diversity.com
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

Auditor I

CGS Administrators LLC
Nashville, TN
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CGS Administrators LLC $19.36$27.36$35.67 life insurance, paid time off, ...
Details
Summary
About the job:
401(k) United States, Tennessee, Nashville Feb 10, 2026 Summary Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plans, and prepares/submits reports on the results of audits....
Location:
Nashville, TN
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
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
apply
Detailed Job Information
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