[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.
• Ensure timely and accurate resolution in compliance with CMS, Medicare, and TennCare guidelines.
• Evaluate cases, determine next steps, and manage multiple priorities while meeting strict turnaround times.
• Review clinical and medical records and summarize findings for Medical Director review.
• Operate within turnaround times as short as 24–72 hours.
• Play a critical role in maintaining regulatory compliance, improving member experience, and supporting 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 and attention to detail.
• A customer-focused approach.
• Knowledge of Medicare, CMS, and TennCare regulations.
• Experience in appeals and grievance processes.
• Clinical knowledge and strong data entry accuracy.
• Case management skills.
• Experience (or interest) in using AI tools such as Copilot to improve efficiency.

We foster a culture where innovation is encouraged, including using AI-enabled tools responsibly to support everyday work.

• 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 of 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, organized, and able to handle multiple projects.
• Excellent oral and written communication skills.
• Strong interpersonal and organizational skills.
• Registered Nurse (RN) with an 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

Applying for this job indicates your acknowledgement and understanding of the following statements:

• BCBST will recruit, hire, train, and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
• Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices.
• BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.