Senior Analyst, Provider Escalations – Associate Manager

CVS Health

Senior Analyst providing solutions to complex provider issues at CVS Health. Engaging with executive leadership and stakeholders to manage sensitive inquiries on healthcare operations.

Posted 4/28/2026full-timeRemote • Oklahoma • 🇺🇸 United StatesSenior💰 $46,988 - $91,800 per yearWebsite

About the role

Key responsibilities & impact

Support the resolution of high-stakes, complex provider issues escalated from executive leadership, regulatory agencies, and legislative offices
Manage sensitive inquiries from the CEO, COO, OHCA, state legislators, and other key stakeholders
Support the Senior Manager in serving as a liaison for provider escalations originating from C-suite executives, OHCA, legislative offices, and other high-priority stakeholders
Act as backup to the Senior Manager, Provider Escalations, assuming full responsibility for escalation management in their absence
Independently manage assigned complex, high-visibility cases from intake through resolution, ensuring timely and satisfactory outcomes
Handle escalated provider issues related to claims processing, roster management, credentialing, payment disputes, and network concerns
Maintain detailed case documentation and provide regular status updates to the Senior Manager, executive leadership, and external stakeholders
Act as a point of contact for providers during critical incidents, demonstrating empathy and professionalism
Prepare executive briefings, response letters, and talking points for leadership regarding sensitive provider matters
Coordinate with Claims, Provider Network, IT, Legal, and Compliance teams to investigate and resolve multi-faceted issues
Conduct root cause analysis to identify systemic problems and prevent recurring escalations
Generate reports on escalation metrics, resolution times, and recurring themes for senior management review
Track and monitor key performance indicators related to provider satisfaction and issue resolution.

Requirements

What you’ll need

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
Knowledge of claims adjudication processes, provider enrollment, and credentialing procedures
Understanding of roster management and eligibility verification processes
Familiarity with state and federal healthcare compliance requirements
Bachelor's degree in Healthcare Administration, Business Administration, or equivalent experience.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

escalation managementclaims processingcredentialingdata analysisroot cause analysisprovider reimbursement methodologiesclaims adjudication processesroster managementeligibility verification processeshealthcare data systems

Soft Skills

empathyprofessionalismcommunicationproblem-solvingleadershiporganizational skillsstakeholder managementconflict resolutionanalytical thinkingattention to detail