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BlueCross BlueShield of Tennessee · 14 hours ago

Provider Research Specialist

United States

Full-time

Remote

Mid Level

3+ years exp

BlueCross BlueShield of Tennessee is seeking a detail-oriented Provider Research Specialist to join their Provider Operation Process Support team. The role involves auditing incoming applications, handling multiple applications simultaneously, and communicating effectively with providers and internal teams to ensure smooth operations.

Health CareMedical

H1B Sponsor Likely

Responsibilities

Monitors provider system data files and creates and maintains contract fact sheets for each contracted provider, including but not limited to: participation in all BCBST networks, special arrangements, and reimbursement data in all BCBST systems

Works closely with Provider Relations and Provider Service Organization staff to resolve provider and member problems or complaints related to provider participation status

Investigates all information associated with contract(s) to ensure accuracy and completeness (i.e., profile form, change forms, provider leaving group forms, signature pages, reimbursement schedules, escalation, incentive, pre-application information, credentialing information and electronic commerce information)

Works closely with the provider community to get corrected data needed from the research of the contracts and forms received prior to having contract data entered and maintained in the FACETS system

Qualification

Credentialing softwareBPMCactusFacetsMicrosoft OfficeMultitasking abilitiesCommunication skillsInterpersonal skillsOrganizational skills

Required

High School Diploma or equivalent

3 years - Experience in a Support function or Customer Service, experience with the military, or coursework towards a related degree

Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)

Proficient oral and written communication skills

Proficient interpersonal and organizational skills

Must have BCBST Research Specialist experience

Preferred

Strong multitasking abilities and proficiency in using multiple applications

Excellent communication skills for interacting with providers and internal teams

Back office or auditing experience

Experience with credentialing software such as Cactus and familiarity with Facets

Company

BlueCross BlueShield of Tennessee

Glassdoor3.8

As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years.

Founded in 1945

Chattanooga, Tennessee, USA

5001-10000 employees

http://www.bcbst.com

H1B Sponsorship

BlueCross BlueShield of Tennessee has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (26)

2024 (38)

2023 (36)

2022 (44)

2021 (56)

2020 (58)