Sr. Business Analyst - QIP

The Senior Care Division is looking for a Senior Business Analyst (QIP) to join their Enrollment and Billing team!

In this role, the Senior Business Analyst will support the Enrollment & Billing department, working closely with Medicare Advantage and Dual Special Needs Plan operations with a strong focus on CMS and compliance. The primary responsibility of this role is to review CMS HPMS memos, interpret regulatory guidance, identify required actions, ensure those actions are implemented accurately and timely, and monitor post‑production outcomes to confirm ongoing compliance. This Analyst will also be responsible for conducting routine and targeted audits of operational processes to ensure adherence to CMS requirements, proactively identifying gaps, and driving corrective actions to maintain regulatory compliance. In addition, this role will also support other Business Analysts with standard analytical activities such as data analysis, reporting, documentation, and issue investigation.

To be successful in this role, in addition to meeting core job requirements, you will bring strong skills as a detail‑oriented analyst who is comfortable translating complex regulatory requirements into clear operational actions while contributing to broader analytical and process improvement efforts.

Notes:

• Sponsorship is not available for this role.
• Though BCBST is a remote-first organization, this role will require a final, on-site interview.
• At BCBST, we foster a culture where innovation is encouraged, including the responsible use of AI-enabled tools to support everyday work. As roles become more advanced, employees are expected to leverage AI, guided by established workflows, templates, and policies, to improve how we serve our members

Job Responsibilities

• Conducting analysis on work procedures and recommending changes to improve the effectiveness of the organization's management.
• Providing management with solutions to increase efficiency.
• Conducting thorough cost/benefit evaluations on various external and internal resources.
• Advising on the design, development, assessment, and implementation of organizational management projects, policies, and/or procedures.

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

Experience

• 2 years - Reporting, data analysis, or similar experience required.
• 1 year - Leadership and/or project management experience required
• 3 years - Technical or operational experience required

Skills\Certifications

• Database reporting skills utilizing Access, Cognos and data warehouse
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Analytical and decision making abilities.
• Proficient in MicroSoft Office (Outlook, Word, Excel, Access and Powerpoint)
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Ability to manage multiple projects and priorities

Number of Openings Available

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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.