Member Appeals & Grievance Analyst – Level 2

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🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Document and investigate the substance of appeals, grievances, or complaints and the action taken, including clinical care or reimbursement issues. • Notify involved parties of review outcomes, including approval or denial of appeals, grievances, or complaints. • Notify CMS and members/appellants of resolutions for CMS complaints within applicable regulatory timeframes. • Provide excellent customer service to members, providers, and CMS. • Maintain knowledge of and adhere to CMS regulations and guidelines affecting the appeal, grievance, and complaint process. • Evaluate cases, determine appropriate next steps, and manage multiple priorities while meeting turnaround times. • Use digital and AI-enabled tools responsibly to improve workflow efficiency.

🎯 Requirements

• Associate's degree or equivalent work experience required • 2 years of customer service and/or claims experience • Knowledge of Medicare and CMS regulations and guidelines related to appeals, grievances, and complaints • Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint • Proficient oral and written communication skills • Proficient interpersonal and organizational skills • Ability to work independently under general supervision and collaboratively in a fast-paced environment • Ability to solve problems and manage multiple assignments with critical deadlines • Ability to analyze claims, medical records, and documents pertinent to case review • Strong analytical skills and attention to detail • Strong data entry accuracy and case management skills • Customer-focused approach • Experience using or enthusiasm for leveraging AI tools such as Copilot • Required weekend coverage every weekend • Agreement to remain in the weekend role for a minimum of 2 years after completion of all training • Sponsorship is not available for this role • Remote positions are unavailable to applicants residing in California, Massachusetts, New Hampshire, New Jersey, or New York

🏖️ Benefits

• Fully remote work arrangement • 40-hour work week • Flexibility based on business needs • Remote-first organization • Potential relocation assistance if residence in Chattanooga, TN is required and eligibility applies