BlueCross BlueShield of Tennessee

• Maintaining financial records in accordance with GAAP and organizational standards. • Creating reports on financial performance for internal and external use. • Performing balance sheet and P&L reconciliations. • Creating and utilizing automated tools for the updating, analyzing and reporting of consolidated financial results.

• Explaining policies, laws and regulations within correspondence clearly • Modifying correspondence documents and templates when necessary • Preparing correspondence received about insurance products, claims, accounts, services, etc. • Distributing and collecting correspondence letters and emails and processing outgoing ones • Working with internal stakeholders to obtain relevant information needed for correspondence • Backing up and/or providing assistance to other positions as needed • Working overtime as required

• Perform prospective and retrospective coverage reviews and appeals per State and Federal regulations. • Serve as a clinical resource to aid in solving basic to mid-level reviews with limited assistance and supervision. • Maintain denial rationale associated with clinical criteria and ensure that decision letters meet regulatory compliance and guidance. • Participate in alternating team on-call rotation.

Role Description We are hiring a Sr. Information Security Governance, Risk, and Compliance (GRC) Analyst at BlueCross BlueShield of Tennessee! In this role, you will help strengthen and mature BCBST’s information security governance program by leading risk management, compliance, and assurance initiatives across the enterprise. - Serve as a key contributor in developing and maintaining Systems Security Plans (SSPs). - Partner with technology and business stakeholders to support audit readiness efforts. - Manage security controls, assess risk, and ensure alignment with industry frameworks and regulatory requirements. - Protect organizational assets while helping BCBST maintain a strong security and compliance posture. To be successful in this role, you'll bring strong cybersecurity knowledge, exceptional technical writing skills, and experience translating complex security requirements into clear, actionable documentation. - Experience developing Systems Security Plans (SSPs). - Supporting audit and compliance activities. - Working with security frameworks and control management programs. - Collaborating across technical teams to manage risk. Professional certifications such as CISA, CISM, or CISSP are highly preferred. Note: This is a remote, work-from-home position, but the final round of interviews will take place on-site in our Chattanooga, TN office. Candidates must be able to work Eastern Time Zone business hours. Participation in an on-call rotation is required for approximately two weeks every 30 weeks. Sponsorship is not available for this role. Qualifications - Bachelor’s degree in a relevant field or an equivalent of four years of experience is required. - 5 years of professional experience in Information Security or related IT roles with security-related responsibilities, including at least 2 years focused on Governance, Risk, and Compliance (GRC) functions. - Experience leveraging AI-enabled tools to automate and enhance GRC processes preferred. Requirements - Preferred certifications: CISSP, CRISC, CISA, or CISM. - Ability to assess and document organizational risks, including identifying impacts and recommending mitigation strategies. - Ability to interpret and apply regulatory requirements and industry frameworks (e.g., NIST, SOC 2, HIPAA) to organizational controls. - Ability to analyze security, compliance, and risk metrics to identify trends and drive continuous improvement. - Ability to communicate complex risk and compliance concepts clearly to both technical and non-technical stakeholders. - Ability to collaborate effectively across cross-functional teams to integrate governance, risk, and compliance practices into business processes. - Exceptional time management skills. - Excellent oral and written communication skills. - Strong interpersonal skills and ability to cultivate relationships with internal and external stakeholders. - Ability to work with all levels of staff and management. Company Description

• Drive the evolution of enterprise authentication and federation experiences • Lead a team focused on designing, building, and scaling authentication solutions • Collaborate with architecture, infrastructure, security, and application development teams • Ensure secure, resilient, and scalable identity services • Direct and develop staff, managing performance and promoting professional development

Role Description We're looking for an individual who has a deep interest in cybersecurity and will bring fresh perspectives and advanced techniques to identify and analyze potential threats. Your expertise will enhance our team’s ability to detect and respond to sophisticated cyber attacks; experience with cloud security is a plus! As Senior Cyber Threat Hunter, you'll help us stay ahead of emerging threats. As a key member of our team, you will play a crucial role in identifying, analyzing, and mitigating cyber threats to protect our organization’s assets and data. Our team is composed of individuals from various backgrounds and experiences, fostering a rich and inclusive culture where everyone’s voice is heard and valued. Every day brings new and exciting challenges. You’ll have the opportunity to tackle complex problems, think creatively, and push the boundaries of what’s possible in cybersecurity. - Sponsorship is unavailable for this role. - This role has an on-call rotation schedule that lasts for 1 week, every 2 months. - While this is a fully remote position, the final round of interviews will take place onsite in our Chattanooga, TN office. Qualifications - Bachelor's Degree in a Computer Sciences related field or equivalent work experience - 5 years of experience in Information Security required - 1 year of experience with information technology concepts, terminology, and standards required Requirements - Common knowledge of malicious code (worms, viruses, spyware, etc.) - Understanding of Security Methodologies for Windows / Linux / Unix operating systems - Knowledge of TCPIP/UDP/ICMP - Working knowledge of the OSI Reference Model - Knowledge of networking components (routers, switches, load balancers, wireless access points, etc.) - Knowledge of Information Security components (IPS, IDS, WAF, SIEM, etc.) - Knowledge of vulnerability assessments - Knowledge of security incident handling - Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability - Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint) - Must be a team player, be organized, and have the ability to handle multiple projects - Excellent oral and written communication skills - Strong interpersonal and organizational skills Company Description

• Lead and manage the enterprise data governance program, including development and maintenance of governance policies, standards, procedures, and decision-rights frameworks. • Define and report business-relevant metrics and KPIs to measure program effectiveness and facilitate appropriate resource allocation. • Oversee the federated stewardship network, including coordination of domain-level Data Owners, Data Stewards, and Business Owners across the hub-and-spoke governance model. • Partner with Legal, Privacy, Compliance, Cyber Security, IAM, and business stakeholders to ensure governance practices align with regulatory requirements. • Develop and maintain the enterprise data classification standard and the authoritative PHI inventory, including ownership assignments, refresh cadence, and pre- and post-sharing gates for regulated data. • Coordinate with technology teams to ensure governance is embedded into data pipelines, metadata management, and technology platforms including Alation, Microsoft Purview, Netskope, and BigQuery. • Develop and oversee AI and GenAI data governance guardrails, including classification-driven data access rules for AI use cases. • Lead change management and adoption efforts for data governance, including development of persona-based enablement materials, training workshops, and stakeholder communications. • Hire, develop, and manage at least one direct report; manage team workload, priorities, and deliverables to ensure alignment with enterprise governance objectives and regulatory timelines.

Role Description We are seeking a dedicated, experienced, and forward-thinking Quality Incentive Consultant to join BlueCross BlueShield of Tennessee. In this role, the Quality Incentive Consultant serves as a strategic driver of quality and cost improvement, translating TennCare’s priorities into actionable initiatives that enhance quality performance, HEDIS outcomes, and overall care delivery for our members. This position partners closely with provider groups, clinical teams, operational leaders, and external stakeholders to assess performance, identify opportunities, and design and implement sustainable improvement strategies. The Consultant leverages data-driven insights, performance analytics, and cross-functional collaboration to ensure accountability and measurable results aligned with enterprise goals. This role is ideal for a candidate who demonstrates: - Proven experience leading quality or performance improvement initiatives from strategy through execution - Strong organizational skills with the ability to manage multiple priorities and maintain attention to detail - Confidence presenting to diverse audiences and influencing provider partners and stakeholders without direct authority - Experience working with provider networks, quality metrics, and/or HEDIS (clinical background not required) - Strong analytical, technical, and digital capabilities, with the ability to translate data into actionable insights - A proactive, innovative mindset with a willingness to leverage enterprise-approved AI and technology to improve quality and efficiency Requirements - This is a fully remote position, although the team is based in Chattanooga, TN. - Candidates must reside in the state of TN. - Must be able to travel up to 20% of the time. - Sponsorship is not available for this role. Job Responsibilities - Work with contracted providers to resolve data issues related to line of business quality programs. - Update and educate contracted providers and their staff of changes and updates to the clinical quality programs. - Serves and educates contracted providers on measures in the line of business quality program, preferred quality reporting, quality measure clinical documentation and BCBST Quality programs policies, procedures, and technologies. - Work with Supervisor to update policies and procedures as needed to improve operations of the line of business quality program. - Travel required approximately 60% of the time. - Various immunizations and/or associated medical tests may be required for this position. Qualifications - Bachelors Degree in a Health Related Discipline (Nursing, Dietetics, Exercise Science, Counseling, Social work, or Health Education) or equivalent work experience required. - 4 years - Quality improvement experience required. - 2 years - Experience in the healthcare industry required. - 1 year - Comprehensive knowledge base crossing all areas within Medicare, HEDIS and CMS Stars program. Skills/Certifications - Demonstrated ability to effectively work with senior leadership teams. - Ability to speak in public and conduct effective presentations. - Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint). - Capacity to solve problems and manage multiple assignments with critical deadlines. - Excellent oral and written communication skills. - Strong analytical skills. - Demonstrated consumer healthcare market understanding/knowledge required. Number of Openings Available - 1 Worker Type - Employee

Role Description SelectCommunity at BCBST is seeking a Registered Nurse Case Manager who is compassionate about case management, advocating for social, emotional, functional, mental, behavioral, and physical health of those who are intellectually and developmentally disabled. In this role, the SelectCommunity Nurse Care Manager (NCM) will: - Assess members’ current status. - Facilitate coordination of long-term services and supports under their insurance benefits and benefits under Department of Disability and Aging. - Collaborate with members, caregivers, conservators, and providers to develop individual, integrated plans of care based on health needs. - Monitor progress for members with multiple levels of acuity. This role requires telephonic contacts and in-person home visits with members on at least a monthly basis and as required by TennCare Contract. Qualifications - Active RN license in the state of Tennessee. - 5 years of experience in the healthcare field (including 3 years of clinical experience). - Reside in Madison County, Gibson County, Dyer County, Obion County, or Weakley County TN as travel is required to meet with members. Requirements - Support utilization management functions for more complex and non-routine cases as needed. - Serve as a liaison between members, providers, and internal/external customers in coordination of health care delivery and benefits programs. - Oversee highly complex cases identified through various mechanisms to ensure effective implementation of interventions and efficient utilization of benefits. - Perform essential activities of case management: assessment, planning, implementation, coordinating, monitoring, outcomes, and evaluation. - Digital positions must have the ability to effectively communicate via digital channels and offer technical support. - This position requires an 18-month commitment before posting for other internal positions. - Various immunizations and/or associated medical tests may be required for this position. - This job requires a digital literacy assessment. Benefits - Grade: BBEX 10 - Incentive Plan AEP - Number of Openings Available: 0

Role Description We are hiring a React Native Mobile Software Engineer on our Mobile Solutions team at BCBST! In this role, you will design, build, and support customer-facing enterprise mobile applications that power critical user experiences across iOS and Android platforms. You’ll work in a fast-paced, highly collaborative environment, partnering with product, design, and backend teams to deliver scalable and high-performing solutions using React Native. This role requires a hands-on engineer who can: - Write clean, maintainable JavaScript/TypeScript code - Develop reusable components - Optimize application performance across devices - Troubleshoot complex issues in distributed systems - Integrate APIs and third-party services - Contribute to engineering best practices through code reviews and continuous improvement To be successful in this role, you’ll bring: - Strong cross-platform mobile development expertise - A deep understanding of React architecture and state management - A proactive, problem-solving mindset You will be a strong candidate if you have experience: - Publishing apps to both the Apple App Store and Google Play Store - Working with native integrations such as push notifications, biometrics, and device APIs - Using tools like Postman or Fiddler for API debugging - With CI/CD pipelines - In native mobile development (Swift, Kotlin, or Java) - Staying current with emerging mobile technologies Note: - This is a remote, work-from-home position aligned to Eastern working hours. - The final round of interviews will take place on-site in our Chattanooga, TN office. - This role includes an on-call rotation of 1 week every 6–7 weeks. - Sponsorship is not available for this role. Qualifications - Bachelors Degree in Computer Science or equivalent work experience required. Equivalent years of experience are determined as one year of technical experience for every year of college requested. - 1 year - Experience with information technology concepts, application development methodology, terminology, and standards required. - 3 years - Systems and programming experience required. - 1 year - Expert working knowledge of at least one programming language in use at BCBST. Requirements - Proven skill with information technology in use at BCBST is required. - Proven analysis, design, and coding skills, and demonstrated success in leading large and complex projects. - Demonstrated ability to interpret and translate technical and/or complex concepts into information meaningful to project team members and/or business personnel. - Be organized, reliable, and able to manage multiple tasks with exceptional work ethic. - Leadership skills. - Must be able to communicate effectively with both technical and non-technical co-workers. Company Description BCBST BlueCross BlueShield of Tennessee, Inc. is committed to recruiting, hiring, training, and promoting 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.