Role Overview
The Senior Analyst will support provider-facing operations with a focus on MAPL-related activities, ensuring accurate claims processing, issue resolution, and provider engagement. This role partners cross-functionally to analyze data, resolve escalations, and drive operational improvements across provider systems and processes.
Key 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, ensuring clear communication of outcomes
- Escalate system and data issues to appropriate partners (e.g., IT) and support root cause analysis and resolution
- Participate in Joint Operating Committee (JOC) discussions and claims escalation calls with assigned health systems
- Educate providers on claims and payment policies, plan design, and operational processes to ensure understanding and compliance
- Partner closely with contracting and network teams to address operational concerns and improve provider experience
- Perform claim reviews for disputes and settlement support as needed
- Triage member and provider issues (e.g., COB, eligibility, plan setup, pending claims) to appropriate teams to ensure timely resolution
- Build and maintain strong, professional relationships with internal stakeholders and external provider partners
- Perform root cause analysis on recurring provider issues, identifying opportunities for process improvement and policy alignment
- Collaborate cross-functionally to resolve escalated issues impacting providers or operational workflows
- Ensure adherence to contract terms, payment policies, and regulatory requirements
- Engage directly with key providers as needed to support service levels and address concerns
Required Qualifications:
- 2-5 years of professional work experience, 1 year in the healthcare industry
- Experience with medical terminology
- Experience working with Microsoft Office Suite
- Ability to travel in the Metro NY Territory as needed
- Proven ability to manage multiple workflows, prioritize effectively, and meet deadlines
- Strong written and verbal communication skills, with the ability to convey complex information clearly
Preferred Qualifications
- Demonstrated experience working with physicians and other healthcare providers
- Strong analytical and problem-solving skills with the ability to interpret complex data and resolve issues
- Experience in claims operations, provider data, or enrollment processes preferred but not required
- Detail-oriented with a focus on accuracy, compliance, and process improvement
Education
High School Diploma or Commensurate Experience
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$46,988.00 - $122,400.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on .
We anticipate the application window for this opening will close on: 09/30/2026
