Appeals & Grievance Intake Analyst

We are hiring an Appeals & Grievance Intake Analyst at BCBST!

In this role, you will serve as the frontline of the department, reviewing and analyzing documents received through multiple intake channels. Using strong critical thinking skills, you will determine what information is being requested, accurately transfer data into internal systems, and ensure cases are distributed to the appropriate teams for further processing.

Your work will have a direct impact on the success of the entire department, as the intake process serves as the foundation for all cases. You will be responsible for managing a high volume of documents, maintaining accuracy and efficiency, and ensuring information is entered correctly to support downstream workflows and timely case resolution.

To be successful in this role, you'll bring strong attention to detail, analytical thinking, and the ability to work independently in a fast-paced environment. You will be a strong candidate if you have experience interpreting complex information, making sound decisions with minimal oversight, and effectively managing multiple priorities. Critical thinking, time management, and data accuracy are essential to success in this position.

We foster a culture where innovation is encouraged. That includes using AI-enabled tools responsibly to support everyday work, guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve our members and improve operational efficiency.

Note

• The working hours for this role is Monday – Friday, 8:00AM – 4:00PM ET, with the latest shift ending at 6:00PM ET.  Rotating call/late stay that ends at 6pm
• This role requires participation in an on-site rotation with other Intake Associates.
• Associates are expected to work on-site approximately one week per month.
• Additional flexibility may be required based on business needs.

Job Responsibilities

• Receive, triage, and distribute work from all sources including hardcopy mail, fax, multiple GM mailboxes, Imaging, department Quality Improvement Organization-fast appeals calls, etc. and documenting the substance of the appeal or grievance/complaint in all applicable systems according to timeliness requirements. Utilize multiple systems in order to appropriately document the substance of the appeals, grievance or complaint. Reroute correspondence as applicable.
• Following up with members and/or providers regarding additional information needs including medical records and Appointment of Representative Forms. This includes detailed documentation of all related Facets inquiries information, claims, utilization management, and case management notes as well as the member’s benefits.
• Mail and fax all departmental outgoing correspondence timely according to CMS notification requirements.
• Maintain knowledge of CMS regulations and guidelines affecting the appeal/grievance/complaint process.
• Identifying information that needs to be rerouted to the appropriate person or area, ensuring that all work has been accurately distributed each day.

Job Qualifications

Education

• High School Diploma or equivalent

Experience

• 1 year - Experience in claims or customer service required

Skills\Certifications

• Attention to detail, exceptional documentation abilities, and organizational skills
• Exceptional time management skills
• If current employee with the company, must meet minimum performance expectations
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Ability to manage multiple projects and numerous personnel simultaneously
• Knowledge of CMS regulations and guidelines related to appeals, grievances and complaints
• Proficient with Facets, CareAdvance and Imaging

Number of Openings Available

Worker Type:

Company:

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.