Quality Assurance Specialist

Salary: Minimum Salary $48,684/month
Compensation: Tenn Care compensation is equitable and based on education and experience in accordance with DOHR policy.
Closing Date: 03/09/2026

The Division of Tenn Care is dedicated to providing our employees with a hybrid work environment. All Tenn Care positions combine work from home and work in the office, varying by position, department, and business need. You may review the specific expectations with the hiring team.

Background Check: This position requires a criminal background check. Applicants may need to provide information about their criminal history.

Tenn Care is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. Tenn Care serves approximately 1.7 million Tennesseans with an annual budget of approximately $14 billion. It operates under the Division of Tenn Care with oversight and some funding from CMS.

Tenn Care's mission is to improve the lives of Tennesseans by providing high-quality, cost-effective care. Employees are empowered to collaborate and improve organizational processes to make a difference in the lives of members. Leadership prioritizes professional and leadership development.

The Division of Tenn Care seeks a Quality Assurance Specialist in the Eligibility Operations Group within Member Services. The role reports to an Eligibility Operations Group Manager. The specialist will work in TEDS processing applications to determine eligibility for regular Tenn Care programs, perform case reviews submitted by contract employees, and lead weekly team meetings. Responsibilities include working with customers, families, facilities, and Authorized Representatives to relay clear information and expectations for accurate eligibility determinations, and documenting actions in TEDS and other systems.

• Review all received documents and make an eligibility determination according to all rules, regulations, policies, and guidelines.
• Process Medicaid applications in a timely manner per established policies and regulations.
• Provide support and guidance to staff on Medicaid rules, regulations, policies, procedures, and organizational databases.
• Evaluate production to ensure accuracy and that production standards are met.
• Participate in training, resources, and tools to increase performance and professional development of staff.
• Provide excellent customer service to internal and external stakeholders.
• Complete secondary reviews for contract employees.
• Lead weekly team meetings with contract employees.

Education and Experience:

• Graduation from an accredited college or university with a bachelor’s degree in a related field (preferred: business administration, management, public health, health policy, paralegal, or legal assistant studies) and 2 years of relevant work experience.
• Or an equivalent combination of education and work experience may be considered.

• Graduation from an accredited college or university with a bachelor’s degree in business administration, management, public health, or health policy and one of the following:
• Four (4) years of experience within Tenn Care or a Medicaid, managed care, or healthcare organization.
• Ability to foster and maintain cohesive working relationships.
• Ability to adapt to changing priorities and deadlines.
• Ability to exercise sound judgment.
• Strong organizational skills, including prioritization, multi-tasking, and managing workload to meet deadlines.
• Advanced writing and communication skills.

State of Tennessee Work­place Discrimination and Harassment policy:
The State is firmly committed to fair and equal employment opportunities, protecting rights and opportunities for all people, and ensuring a workplace free of discrimination and harassment based on race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other protected category in state and federal civil rights laws.