BlueCross BlueShield of Tennessee

Full-stack Engineer

• Support the analysis of complex enterprise system integrations
• Help develop flexible, scalable communication solutions using ASP.NET, Web APIs, and SQL
• Formulates and defines system scope and objectives through research and fact-finding
• Devises or modifies application systems and procedures to optimize functional requirements
• Designs, codes, tests, debugs, and documents programs, subroutines, and scripts
• May serve one or more project team roles
• Maintains technical skill set for software languages, databases, platforms, operating systems, utilities and networks needed to support work assignments
• Responds to system failures and performance events

Software Engineer

IT Support

• Manages the day-to-day operations of a team with a focus on the maintenance and development of systems and supervising system modifications.
• Assigns, monitors, and reviews progress and accuracy of work.
• Provides staff management oversight including hiring, promoting, or making recommendations for staff.
• Conducts performance reviews and assessments, manages performance, engages in skills assessment, and promotes professional development of staff.
• Ensures adherence to policies, plans, objectives, budgets and staffing allocations.
• Manages and tracks team-level project details and serves as the technical subject matter expert and provides leadership during periods of transition.

EIT Engineering Team Lead

QA Engineer

• Validate end‑to‑end functionality, integrations, data flows, and user experiences within Salesforce.
• Collaborate with cross-functional teams to execute comprehensive test plans and identify defects early in the development cycle.
• Create and execute test scripts for functional, automation and/or performance testing.
• Review technical design documents and develop E2E integration test scenarios.
• Identify and create test data, build, and execute services/API validation scripts.

SQA Analyst II

Manager

• Supporting utilization management functions for more complex and non-routine cases as needed.
• Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
• Overseeing highly complex cases to ensure effective implementation of interventions, and to ensure efficient utilization of benefits.
• Performing the essential activities of case management: assessment, planning, implementation, coordinating, monitoring, outcomes and evaluation.

Case Manager

• Auditing provider documentation and supporting HEDIS quality initiatives
• Analyzing clinical data to identify gaps and performance opportunities
• Partnering with provider offices to enhance Stars performance
• Ensuring compliance with regulatory and organizational standards
• Supporting provider outreach to strengthen quality measures across the network
• Presenting and communicating audit results to appropriate parties
• Schedule and perform routine facility, practitioner site, and medical record reviews
• Identifying and evaluating areas of exposure, potential problems and liabilities
• Analyze clinical data to improve individual provider compliance with education
• Providing required documents and consulting support for quality and compliance audits

Clinical Quality Assurance Auditor

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Clinical Review Manager

User Researcher

• Conduct user research, using both qualitative and quantitative techniques
• Analyze and synthesize data to generate meaningful insights and actionable recommendations
• Document and share research findings to internal clients and leadership in engaging presentation-format

UX Researcher

Consultant

• Perform ongoing and ad-hoc research to help answer questions around business performance, data anomalies and future claim projections.
• Summarize findings for logical presentation and work with business contacts to develop effective product and process solutions.
• Developing and Maintaining the database of past claims to support the actuarial processes of determining premium rates for health insurance products.
• Analyze large amounts of complex data for drivers of business and/or industry trends.
• Ensure that any ad hoc data requests are done in an accurate and timely manner and presented in a clear, organized fashion.

Senior Data Consultant

Actuary

• Develop models to be used for pricing, forecasting, or valuation of the Commercial and Government lines of business.
• Retrieve and/or prepare data to be used in model development.
• Monitor emerging experience and analyze actual vs. expected results.
• Present technical work results to supervisor and peers.
• Prepare documentation of methods and assumptions used in the models and experience monitoring.
• Perform technical peer review for others in the Actuarial Division.

Actuarial Assistant

• Lead the Reporting, ETL & Business Intelligence Dashboards team
• Responsible for maintenance and modernization of enterprise reporting and dashboard capabilities
• Overseeing multiple application programming and analysis projects, including development installation, and maintenance of application programs
• Maximizing staff contribution through professional growth and development
• Analyzing applications to ensure developed systems are meeting business needs and specifications

Application Manager

Operations

• Manages the day-to-day operations of a team with a focus on the monitoring of systems, fulfillment of requests, and process optimization.
• Assigns, monitors, and reviews progress and accuracy of work.
• Provides staff management oversight including hiring, promoting, or making recommendations for staff.
• Conducts performance reviews and assessments, manages performance, engages in skills assessment, and promotes professional development of staff.
• Directs, motivates, and develops staff, maximizing their individual contribution, professional growth, and ability to function effectively with their colleagues as a team.
• Ensures adherence to policies, plans, objectives, budgets and staffing allocations.
• Actively participates in project teams, manages and tracks team-level project details, and provides leadership during periods of transition.
• Employees may be required to participate in a weekly on-call rotation.

EIT Operations Team Lead

Research Analyst

• Conducting opinion research to determine public support for additional product prospects, advertising, brand reputation and customer experience.
• Analyzing competitors' products, prices, sales, and methods of marketing to determine the advisability of adding new lines of merchandise and operations.
• Collecting data regarding competitors' products, prices, sales, and methods of marketing, as well as methods and procedures for obtaining their data.

Market Research Analyst

Analyst

• Design, development, assessment, and implementation of organizational management projects, policies, and/or procedures
• Identifying business process improvement projects for internal business groups
• Conducting cost/benefit evaluations on various external and internal resources
• Analyzing business requirements and production specifications

Product Strategy Analyst

• Conduct onsite visits to local Acute Inpatient Psychiatric facility in the Murfreesboro area
• Participate in treatment team meetings, sharing insights on member cases
• Assist members in finding appropriate care or resources post-discharge
• Collaborate with providers and internal teams to meet member needs and resolve challenges
• Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions

Behavioral Health Case Manager

• Manage prior authorization for home health and DME services
• Oversee home health case managers supporting medically complex members
• Ensure timely medically necessary in-home services
• Participate in developing strategies, policies, and procedures related to clinical management programs
• Manage a team(s) of clinical staff to assure effectiveness