Remote RN Appeals & Grievance Analyst

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); On-site; USD 75,000 - 95,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. is hiring an Appeals & Grievance Nurse Analyst in a fully remote capacity.

The role focuses on reviewing and processing member and provider appeals, ensuring timely, compliant resolutions in line with CMS, Medicare, and TennCare guidelines. You will evaluate cases, manage multiple priorities within strict 24–72 hour turnaround times, and use AI tools to enhance efficiency.

Qualifications

• 3 years of clinical nursing experience required.
• Strong analytical and detail-oriented approach needed.
• Familiarity with Medicare, CMS and TennCare regulations advantageous.
• Proficient with Microsoft Office (Outlook, Word, Excel, PowerPoint).
• Experience with appeals and grievance processes is a plus.

Responsibilities

• Review and process member and provider appeals and QOC grievances.
• Ensure timeliness and quality per regulations and guidelines.
• Research and document the substance and validity of appeals; prepare case files for Medical Director review.
• Draft detailed appeal and grievance response letters with recommendations for improvement.
• Collaborate with clinical and non-clinical staff to resolve issues and ensure quality of care.

Skills

Analytical skills

Attention to detail

Customer-focused

MS Office proficiency

Team oriented

Education

RN license

Tools

Copilot

Job description

BlueCross BlueShield of Tennessee, Inc. is hiring an Appeals & Grievance Nurse Analyst in a fully remote capacity.

The role focuses on reviewing and processing member and provider appeals, ensuring timely, compliant resolutions in line with CMS, Medicare, and TennCare guidelines. You will evaluate cases, manage multiple priorities within strict 24–72 hour turnaround times, and use AI tools to enhance efficiency.