Senior Claims & Provider Relations Analyst

CVS Health Corporation; New York, Northern (NY, KY); Hybrid; USD 47,000 - 122,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health Corporation in New York, NY seeks a Senior Analyst to support provider-facing operations with MAPL-related activities, ensuring accurate claims processing and issue resolution. You will analyze data, resolve escalations, and drive improvements across provider systems and processes.

Responsibilities include claims analysis, ticket management, root cause analysis, and educating providers on policies.

Qualifications

• 2-5 years of professional work experience with healthcare exposure.
• Experience with medical terminology is required.
• Proficiency in Microsoft Office Suite for data analysis.
• Ability to travel within the Metro NY Territory as needed.
• Strong written and verbal communication with multitasking ability.
• Experience resolving provider questions and escalations.

Responsibilities

• Conduct detailed claims and spreadsheet analysis within turnaround times.
• Manage intake and resolution of operational requests and tickets.
• Escalate system and data issues and support root cause analysis.
• Participate in JOC discussions and provider escalation calls.
• Educate providers on claims, policies, and processes.
• Collaborate with contracting and network teams to improve provider experience.
• Perform claim reviews for disputes and settlement support.
• Triage provider issues to ensure timely resolution.
• Build strong relationships with internal and external stakeholders.
• Perform root cause analysis on recurring issues and drive improvements.
• Coordinate cross-functional resolution of escalated issues.
• Ensure adherence to contract terms, payment policies, and regulatory requirements.

Skills

Healthcare experience

Medical terminology

Multitasking & prioritization

Strong communication

Data live analysis

Team collaboration

Education

High School Diploma or commensurate experience

Tools

Microsoft Office Suite

Job description

CVS Health Corporation in New York, NY seeks a Senior Analyst to support provider-facing operations with MAPL-related activities, ensuring accurate claims processing and issue resolution. You will analyze data, resolve escalations, and drive improvements across provider systems and processes.

Responsibilities include claims analysis, ticket management, root cause analysis, and educating providers on policies.