BlueCross BlueShield of Tennessee

Sr. Business Analyst - QIP

BlueCross BlueShield of Tennessee · Full Time · 5 hours ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

The role focuses on interpreting CMS regulatory guidance and ensuring compliance within Enrollment and Billing operations for Medicare Advantage and Dual Special Needs Plans. Responsibilities include conducting operational audits, identifying gaps, and supporting broader analytical activities and reporting.

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Provider Quality Consultant (Tennessee Based)

BlueCross BlueShield of Tennessee · Full Time · 7 hours ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Consultant drives quality and cost improvement initiatives by translating TennCare priorities into actionable strategies for provider groups. They conduct provider visits and leverage data-driven insights to enhance HEDIS outcomes and overall care delivery.

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Associate Data Engineer II

BlueCross BlueShield of Tennessee · Full Time · a day ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Build and optimize scalable data pipelines to support critical system integrations and enterprise analytics. Collaborate with stakeholders to design, test, and debug programs while participating in an on-call rotation to reduce system downtime.

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Clinical Review Manager

BlueCross BlueShield of Tennessee · Full Time · a day ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Perform clinical and financial reviews of paid and pending claims to provide insights on cost and utilization. Present complex clinical and financial concepts to external stakeholders and employer groups to demonstrate the value of care management.

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Associate Data Engineer I

BlueCross BlueShield of Tennessee · Full Time · a day ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 0-2 yrs exp 💼 Software Development

Develop and maintain data pipelines to support vendor integrations and analytics workflows. Collaborate with stakeholders to design, test, and troubleshoot scalable data solutions and resolve data quality issues.

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Health Navigator

BlueCross BlueShield of Tennessee · Full Time · a day ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Serve as a key point of contact for members to help them navigate healthcare needs and complete Health Risk Assessments. Manage system work queues and coordinate care by referring members to population health management programs.

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EIT Service Desk Specialist

BlueCross BlueShield of Tennessee · Full Time · a day ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Support

Provide tier one technical support for business lines and applications via phone, chat, and self-service. Monitor communications to ensure timely resolution of incidents and escalate complex problems according to procedure.

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Supervisor Case Management

BlueCross BlueShield of Tennessee · Full Time · 2 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Lead and coach a team of care managers to ensure high-quality delivery of maternity and neonatal case management programs. Oversee daily workflows, productivity, and quality audits to improve clinical outcomes and financial performance.

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Senior Platform Engineer

BlueCross BlueShield of Tennessee · Full Time · 2 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

Manage the onboarding and monitoring of network devices, focusing on availability and performance metrics. Collaborate with Network Engineering to optimize monitoring strategies and maintain enterprise monitoring solutions.

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Principal Ethics and Compliance Consultant

BlueCross BlueShield of Tennessee · Full Time · 3 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 10+ yrs exp 💼 Legal

Lead enterprise-wide compliance initiatives and serve as a subject matter expert for regulatory research and interpretation. Coordinate sensitive reviews with government agencies and manage complex projects including change management processes.

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Senior Data Consultant

BlueCross BlueShield of Tennessee · Full Time · 3 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Perform research on business performance and data anomalies to support actuarial processes and claim projections. Summarize complex data findings to develop effective product and process solutions for health insurance premium rates.

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Sr. Software Engineer

BlueCross BlueShield of Tennessee · Full Time · 5 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

Lead the technical implementation of AI-assisted tools to optimize the software development lifecycle and platform engineering standards. Design, code, and document complex information systems while acting as a technical expert for development staff.

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Senior AI Engineer

BlueCross BlueShield of Tennessee · Full Time · 5 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

Lead the design, development, and productionalization of advanced AI and Generative AI solutions for healthcare payer use cases. Collaborate with cross-functional teams to architect scalable systems and mentor junior engineers on AI best practices.

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Cyber Threat Hunter

BlueCross BlueShield of Tennessee · Full Time · 5 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Sales

Identify, analyze, and report hidden threats within the enterprise network to protect organizational assets and data. Develop security standards and participate in penetration testing and vulnerability assessments to enhance network security.

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Transition of Care Nurse

BlueCross BlueShield of Tennessee · Full Time · 5 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Guide members transitioning from higher to lower levels of care by ensuring comprehensive discharge plans and member safety. Collaborate with hospital care coordination teams to evaluate clinical status and manage resource utilization for cost-effective outcomes.

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Software Engineer

BlueCross BlueShield of Tennessee · Full Time · 5 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Maintain and enhance internal-facing applications to support critical claims processing while modernizing legacy systems. Design, code, test, and document complex information systems and provide guidance to less-experienced programmers.

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Quality Incentive Consultant-Chattanooga Region

BlueCross BlueShield of Tennessee · Full Time · 6 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Collaborate with contracted providers to resolve data issues and improve clinical quality program performance. Educate providers on quality measures, documentation, and policies to enhance patient satisfaction and quality ratings.

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Provider Data Consultant

BlueCross BlueShield of Tennessee · Full Time · 6 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Support technical solutions for managing provider networks by designing and enhancing reporting, data integrations, and tools. Drive efficiency through automation and AI-enabled solutions to improve provider credentialing and data quality.

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Associate MLOps Engineer

BlueCross BlueShield of Tennessee · Full Time · 6 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

The role focuses on building, deploying, and operating machine learning solutions at scale while automating ML pipelines. Responsibilities include monitoring model performance for drift and collaborating with data scientists to integrate models into business processes.

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Associate Data Enablement Engineer II

BlueCross BlueShield of Tennessee · Full Time · 6 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Maintain and expand financial data infrastructure, including ETL/ELT pipelines and curated data layers using Databricks and SQL. Translate business and financial requirements into scalable data solutions to support reporting and planning.

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Sr. Data Engineer

BlueCross BlueShield of Tennessee · Full Time · 7 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

Lead a collaborative data engineering team to build and maintain production-grade data pipelines for regulatory reporting such as HEDIS and CMS. Design automated pipelines in a cloud environment to enable governed datasets and AI-driven self-service analytics for business partners.

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Appeals & Grievance Nurse Analyst

BlueCross BlueShield of Tennessee · Full Time · 8 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Review and process member and provider appeals and grievances in compliance with CMS, Medicare, and TennCare guidelines. Analyze clinical records to summarize findings for Medical Director review and draft individualized response letters.

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Coding Auditor

BlueCross BlueShield of Tennessee · Full Time · 8 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

Perform detailed claims payment quality reviews and coding compliance audits for hospital claims to ensure appropriate reimbursement. Communicate audit results to facilities and recommend corrective actions to improve accuracy and compliance.

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Outreach Pharmacy Specialist

BlueCross BlueShield of Tennessee · Full Time · 9 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The specialist conducts outbound educational calls to members, prescribers, and pharmacists to improve medication adherence. They are responsible for monitoring pharmacy information and handling customer service inquiries via telephone.

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Senior Cyber Security Engineer

BlueCross BlueShield of Tennessee · Full Time · 12 days ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 5-10 yrs exp 💼 Software Development

The role involves embedding security into solution design, deployment, and modernization efforts across the enterprise. Responsibilities include conducting risk assessments, managing cloud security solutions, and implementing security automation for testing and configuration monitoring.

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Senior AI Workflow Engineers

BlueCross BlueShield of Tennessee · Full Time · a month ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 2-5 yrs exp 💼 Software Development

Design, build, and operationalize AI-enabled workflows to improve enterprise efficiency and outcomes. Partner with security and legal teams to ensure compliance with healthcare regulations while leading AI adoption across the organization.

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AI Workflow Engineers

BlueCross BlueShield of Tennessee · Full Time · 3 months ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 0-2 yrs exp 💼 Software Development

Responsibilities include assisting with simple coding tasks, model configuration, and data preparation under supervision, alongside performing hands-on learning exercises to build familiarity with Python, AI tools, and cloud environments. Engineers will also support basic agent-building activities and participate in innovation sessions.

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Manager eBusiness Development

BlueCross BlueShield of Tennessee · Full Time · 7 months ago

BlueCross BlueShield of Tennessee

🌎 United States ⭐ 10+ yrs exp 💼 Others

Lead the design, development, and delivery of enterprise-grade applications while ensuring compliance with quality standards. Manage vendors and contracts, and mentor developers to inspire high performance and teamwork.

architecture project-management leadership history compliance

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