Appeals & Grievance Intake Analyst

BlueCross BlueShield of Tennessee • Chattanooga, TN

3d • Hybrid

About The Position

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.

Requirements

• High School Diploma or equivalent
• 1 year - Experience in claims or customer service required
• Attention to detail, exceptional documentation abilities, and organizational skills
• Exceptional time management skills
• 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

Nice To Haves

• If current employee with the company, must meet minimum performance expectations

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED