Senior Provider Relations Analyst – Claims & Ops

Jobtailor; New Jersey; On-site; USD 60,000 - 90,000; Full time

Job summary

Jobtailor in New Jersey is seeking an experienced claims operations professional to analyze complex claims and manage provider inquiries. You will collaborate with health systems, educate providers on policies, and drive process improvements across the claims lifecycle.

The role requires strong analytical abilities, knowledge of medical terminology, and proficiency with the Microsoft Office Suite to support accurate data handling and timely resolutions.

Qualifications

• Experience in claims operations and provider relations within healthcare.
• Knowledge of medical terminology and enrollment processes.
• Proficient in Microsoft Office; strong data handling and spreadsheet skills.

Responsibilities

• Conduct detailed claims and spreadsheet analysis within established turnaround times.
• Manage intake and resolution of NEF tickets, SNOW tickets, and other provider-related inquiries.
• Escalate system and data issues and support root cause analysis.
• Participate in Joint Operating Committee discussions and claims escalation calls with assigned health systems.
• Educate providers on claims, payment policies, plan design, and operational processes.
• Partner with contracting and network teams to address operational concerns and improve provider experience.
• Perform claim reviews for disputes and settlement support.
• Triage member and provider issues, including COB, eligibility, plan setup, and pending claims.
• Build and maintain relationships with internal stakeholders and external provider partners.
• Perform root cause analysis on recurring provider issues and identify process improvements.
• Collaborate cross-functionally to resolve escalated issues affecting providers or operational workflows.
• Ensure adherence to contract terms, payment policies, and regulatory requirements.
• Engage directly with key providers to support service levels and address concerns.

Skills

Claims Operations

Healthcare Industry Knowledge

Analytical Skills

Microsoft Office Proficiency

Effective Communication

Education

High School Diploma or GED

Tools

NEF Tickets

SNOW Tickets

Microsoft Office Suite

Job description

Jobtailor in New Jersey is seeking an experienced claims operations professional to analyze complex claims and manage provider inquiries. You will collaborate with health systems, educate providers on policies, and drive process improvements across the claims lifecycle.

The role requires strong analytical abilities, knowledge of medical terminology, and proficiency with the Microsoft Office Suite to support accurate data handling and timely resolutions.