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CVS Health

Bringing our heart to every moment of your health.

Senior Analyst, Provider Escalations

AnalystAnalystFull TimeRemoteSeniorTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Oklahoma

Posted

1 day ago

Salary

$47.0K - $91.8K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

• Support the Senior Manager in serving as a liaison for provider escalations from C-suite executives, OHCA, and legislative offices • Assist in overseeing the ABHOK Escalations Mailbox and respond to inquiries within 24 to 48 hours • Independently manage assigned complex, high-visibility cases from intake through resolution • Handle escalated provider issues related to claims processing, credentialing, and payment disputes • Maintain detailed case documentation and provide regular status updates • Assist in preparing executive briefings and response letters for leadership • Coordinate with Claims, Provider Network, IT, Legal, and Compliance teams to resolve issues • Conduct root cause analysis to identify systemic problems • Generate reports on escalation metrics and track key performance indicators

Job Requirements

  • Minimum 5-7 years of progressive experience in healthcare operations, provider relations, or managed care
  • Minimum 2-3 years in a supervisory or escalation management role handling complex cases
  • Proven experience working with Medicaid programs, regulatory agencies, and government stakeholders
  • Advanced proficiency with QNXT claims processing system
  • Expert-level knowledge of CRM platforms (Salesforce or similar)
  • Strong proficiency with Microsoft Office Suite, particularly Excel for data analysis
  • Experience with ticketing/case management systems and reporting tools
  • Familiarity with healthcare data systems and electronic health record platforms
  • Comprehensive understanding of Medicaid policies, regulations, and provider reimbursement methodologies
  • Bachelor's degree in Healthcare Administration, Business Administration, or equivalent experience.

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • Wellness screenings, tobacco cessation and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off, flexible work schedules, family leave, dependent care resources, and colleague assistance programs
  • Tuition assistance
  • Retiree medical access

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