BlueCross BlueShield of Tennessee is hiring a HEDIS Technical Manager. In this critical leadership role, you’ll own the technical execution of our HEDIS program, with primary responsibility for HEDIS reporting systems, audits, and vendor delivery that support NCQA accreditation and Medicare Advantage Star Ratings. In addition to managing our Cotiviti relationship (and a team of internal specialists), you’ll serve as the technical authority for HEDIS specifications, digital measures and audit response Ideal candidates for this role will bring: Deep payer‑side HEDIS experience, including strong clinical and technical understanding of HEDIS specifications, codes, and audit requirements Hands‑on experience owning or leading HEDIS audits and responding to NCQA audit inquiries Vendor management experience with HEDIS Cotiviti Platform (or similar HEDIS platform) Technical fluency with healthcare data and analytics (SQL, Google BigQuery, GCP experience) Familiarity with digital HEDIS measures, interoperability standards (FHIR), and evolving NCQA quality reporting models If you’re inspired by our mission – peace of mind through better health – and ready for a role where your HEDIS expertise will have a direct influence on enterprise quality outcomes, we’d love to hear from you. Job Description/ Job Responsibilities Works with internal and external stakeholders to deliver effective analytic solutions that meet business needs Assesses the scope and resources required for a wide variety of analytic requests, data modifications and enhancements and special projects Identifies necessary resource requirements and tracks assignments to ensure timely completion Escalates issues appropriately and works with senior management for resolution Monitors and communicates key performance metrics and operational challenges. Job Qualifications Education Bachelor's Degree in a Business, Computer Sciences or related fields or equivalent work experience Experience 8 years - Extensive systems analysis, design and project management experience required. 5 years - Experience in a leadership/management role required SkillsCertifications Ability to comprehend technical instructions and explain/breakdown problems and issues Working knowledge of healthcare claims, customer service, provider network contracting, and contract compliance Demonstrated ability to effectively work with senior leadership teams Proven leadership abilities that promote growth and development of employees Self-motivated and able to manage multiple tasks and set priorities. Excellent oral and written communication skills Strong interpersonal and organizational skills Possess interviewing and hiring skills Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. 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. As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST. 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 members. BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.
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