[Hiring] Appeals & Grievance Nurse Analyst @BlueCross BlueShield of Tennessee

Role Description

We are hiring an Appeals & Grievance Nurse Analyst at BCBST! In this role, you will review and process appeals submitted by members and providers, ensuring timely and accurate resolution in compliance with CMS, Medicare, and TennCare guidelines. You will evaluate cases, determine next steps, and manage multiple priorities while meeting strict turnaround times.

• Review clinical and medical records, summarize findings for Medical Director review, and operate within turnaround times as short as 24–72 hours.
• Maintain regulatory compliance, improve member experience, and support high-quality outcomes through detailed case analysis and effective use of digital tools.

To be successful in this role, you’ll bring strong analytical skills, attention to detail, and a customer-focused approach. You will be a strong candidate if you have knowledge of Medicare, CMS, and TennCare regulations, along with experience in appeals and grievance processes. Clinical knowledge, strong data entry accuracy, case management skills, and experience (or interest) in using AI tools such as Copilot to improve efficiency will further strengthen your candidacy.

• This is a fully remote role with a 40-hour workweek; flexibility is required based on business needs, including potential weekend coverage.
• Sponsorship is not available for this role.

Qualifications

• 3 years - Clinical nursing experience required.

Requirements

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
• Must be a team player, be organized and have the ability to handle multiple projects.
• Excellent oral and written communication skills.
• Strong interpersonal and organizational skills.
• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Company Description

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via email, the Internet, or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.