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

Role Description

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

• Play a critical role in maintaining regulatory compliance.
• Improve member experience and support high-quality outcomes through detailed case analysis.
• Effectively use digital tools to drive efficiency.

To be successful in this role, you'll bring:

• Strong analytical skills and attention to detail.
• A customer-focused approach.
• Knowledge of Medicare and CMS regulations.
• Experience with the appeals and grievance process.
• A clinical background or prior experience in a healthcare setting (preferred).
• Strong data entry accuracy and case management skills.
• Experience using or enthusiasm for leveraging AI tools (e.g., Copilot) to improve workflow efficiency.

This is a fully remote role with a 40-hour work week, with flexibility required based on business needs, including required weekend coverage every weekend. An agreement to remain in the weekend role for a minimum of 2 years after completion of all training is required. Sponsorship is not available for this role.

Qualifications

• Associates degree or equivalent work experience required.
• 2 years - Customer service and/or claims experience.

Requirements

• Proficient in Microsoft Office (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 as part of a team in a fast-paced environment.
• Capacity to solve problems and manage multiple assignments with critical deadlines; including analyzing claims, medical records & documents pertinent to the case review.
• Knowledge of CMS regulations and guidelines related to appeals, grievances, and complaints.

Company Description