Provider Operations Analyst: Claims & Insights

CVS Health Corporation; United States; On-site; USD 47,000 - 122,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Full-time position

Job summary

CVS Health Corporation is seeking a Senior Analyst to support provider-facing operations with a focus on MAPL-related activities, ensuring accurate claims processing and issue resolution. You will collaborate across teams to analyze data, manage escalations, and drive improvements in provider systems and processes.

The role requires 2–5 years of healthcare experience, strong MS Office skills, and the ability to travel within the Metro NY Territory.

Qualifications

• 2-5 years of professional work experience, 1 year in the healthcare industry
• Experience with medical terminology
• Ability to travel in the Metro NY Territory as needed

Responsibilities

• Conduct detailed claims and spreadsheet analysis within established turnaround times to identify issues, trends, and resolution pathways
• Manage intake and resolution of operational requests, including NEF tickets, SNOW tickets, and other provider-related inquiries
• Escalate system and data issues to appropriate partners and support root cause analysis and resolution
• Educate providers on claims and payment policies, plan design, and operational processes to ensure understanding and compliance
• Partner with contracting and network teams to address operational concerns and improve provider experience

Skills

Healthcare operations

Microsoft Office

Claims processing

Communication skills

Travel flexibility

Education

High School Diploma or equivalent

Job description

CVS Health Corporation is seeking a Senior Analyst to support provider-facing operations with a focus on MAPL-related activities, ensuring accurate claims processing and issue resolution. You will collaborate across teams to analyze data, manage escalations, and drive improvements in provider systems and processes.

The role requires 2–5 years of healthcare experience, strong MS Office skills, and the ability to travel within the Metro NY Territory.