We are hiring a Business System Consultant to support the Information Delivery – HEDIS Data Management team at BCBST!
In this role, you will serve as the business owner and functional steward for HEDIS data systems and processes, ensuring HEDIS data is accurate, validated, audit‑ready, and available for reporting, submissions, and regulatory compliance. You will provide business oversight for annual and weekly HEDIS runs, including readiness checks, validation checkpoints, PSV failure research, and post‑run decisions that ensure data integrity and submission accuracy. Acting at the intersection of business, data, and technology, you’ll translate NCQA and Cotiviti HEDIS specifications into validated system outcomes and partner closely with data engineering, infrastructure, quality reporting, analytics, and audit teams to maintain operational stability. This role is critical to sustaining continuity for ongoing HEDIS operations and ensuring systems remain reliable and usable throughout the measurement year.
To be successful in this role, in addition to the core job requirements, you will bring strong experience with business system ownership, operational analysis, and cross‑functional coordination in a complex data environment. You will be a strong candidate if you have experience supporting regulated data systems, conducting data validation and audit support, interpreting evolving HEDIS specifications, and translating complex technical or regulatory requirements into clear, actionable expectations for business and technology partners. Excellent communication skills, the ability to manage multiple priorities, and comfort serving as a central coordination point across teams are essential.
Note:
- This is a fully remote role; however, the final round of interviews will take place onsite in our Chattanooga, TN office
- Sponsorship is not available for this role
Job Responsibilities
- Providing senior level consulting services to internal business groups on process improvement projects designed to improve their business results.
- Analyzing, defining and documenting clients requirements, and revising existing systems logic challenges, as necessary.
- Monitoring client experiences and feedback on the use of business applications; Enhancing system productivity, as needed.
- Participating in identifying, evaluating, and developing systems that are cost effective and meet business requirements.
Job Qualifications
Education
- Bachelor's degree in Computer Science, Engineering, or a related discipline, or commensurate experience in a professional environment, required.
Experience
- 1 year - Leading requirements development efforts required
- 5 years - Experience in Information Technology required
- 1 year - Advanced experience with operational analysis, design and understanding of integrated, interdependent and interfaced systems and their impacts on each other.
Skills\Certifications
- Knowledge of information technology concepts, application development methodology, terminology, and standards to actively conduct and/or engage in hardware and software related discussions relative to all assigned projects.
- Demonstrated ability to interpret and translate technical and/or or complex concepts into information meaningful to project team members and/or business personnel.
- Outstanding negotiation, presentation, and facilitation skills
- Excellent oral and written communication skills
- Ability to manage multiple projects and priorities
Number of Openings Available
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
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. 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.
