Appeals & Grievance Intake Specialist

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); Hybrid; USD 42,000 - 66,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. is seeking an Appeals & Grievance Intake Analyst to review and route incoming documents, document the appeal substance, and support timely case resolution.

You will work with multiple systems to ensure accurate data transfer and proper distribution to the correct teams. In a fast-paced, detail-driven environment, you will interpret complex information, manage multiple priorities, and leverage AI-enabled tools within approved workflows to improve efficiency

Qualifications

• High School Diploma or equivalent.
• 1 year experience in claims or customer service.
• Proficiency with CMS regulations related to appeals, grievances and complaints.
• Proficient with Facets, CareAdvance and Imaging systems.
• Strong data entry and documentation abilities.
• Excellent written and verbal communication.

Responsibilities

• Receive, triage, and distribute work from all sources and document the appeal or grievance in systems.
• Utilize multiple systems to document the substance of the appeal or grievance.
• Reroute correspondence as applicable.
• Follow up with members/providers for additional information including medical records.
• Document all related inquiries, claims, utilization management, and benefits notes.
• Mail and fax departmental outgoing correspondence timely per CMS requirements.
• Maintain knowledge of CMS regulations affecting the process.
• Identify information needing reroute and ensure daily distribution.

Skills

Attention to detail

Documentation skills

Organizational skills

Time management

Oral communication

Written communication

Interpersonal skills

Multitasking

Education

High School Diploma or equivalent

Tools

Facets

CareAdvance

Imaging

Job description

BlueCross BlueShield of Tennessee, Inc. is seeking an Appeals & Grievance Intake Analyst to review and route incoming documents, document the appeal substance, and support timely case resolution.

You will work with multiple systems to ensure accurate data transfer and proper distribution to the correct teams. In a fast-paced, detail-driven environment, you will interpret complex information, manage multiple priorities, and leverage AI-enabled tools within approved workflows to improve efficiency