Senior Analyst, Provider Escalations (Associate Manager)

CVS Health

35d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Aetna Better Health is seeking an experienced Senior Analyst, Provider Escalations (Associate Manager) to support the resolution of high-stakes, complex provider issues escalated from executive leadership, regulatory agencies, and legislative offices. Working closely with the Senior Manager, Provider Escalations, this role manages sensitive inquiries from the CEO, COO, Oklahoma Health Care Authority (OHCA), state legislators, and other key stakeholders. The ideal candidate will demonstrate strong crisis management skills, professional presence, and the ability to navigate complex healthcare operations while maintaining positive provider relationships during challenging situations. This position is based in Oklahoma and operates in a remote capacity.

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
• Technical Skills Required: Advanced proficiency with QNXT claims processing system
• Required: 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
• Healthcare Knowledge 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
• Core Competencies Exceptional organizational skills with ability to manage multiple high-priority, time-sensitive issues simultaneously
• Crisis management skills with proven ability to remain calm and solution-focused under pressure
• Strong communication skills – both written and verbal – with ability to translate complex technical issues for diverse audiences
• Emotional intelligence and de-escalation skills to manage difficult conversations with diplomacy and professionalism
• Strong analytical and problem-solving abilities to diagnose root causes and develop comprehensive solutions
• Professional presence with ability to interact confidently with senior leaders and government officials
• Collaborative approach with ability to work effectively across multiple departments
• Detail-oriented mindset with commitment to accuracy and thoroughness in documentation

Nice To Haves

• Experience working directly with state health departments or Medicaid agencies
• Master's degree preferred
• Prior exposure to legislative inquiries or constituent services

Responsibilities

• Escalation Management & Case Ownership 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
• Assist in overseeing the ABHOK Escalations Mailbox, ensuring all inquiries are acknowledged and responded to within 24 to 48 hours
• 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
• Ensure all case documentation is completed accurately and timely within the PEERS System
• Maintain detailed case documentation and provide regular status updates to the Senior Manager, executive leadership, and external stakeholders
• Stakeholder Relations & Communication Act as a point of contact for providers during critical incidents, demonstrating empathy and professionalism
• Defuse tense situations with dissatisfied providers while protecting organizational interests and maintaining compliance
• Assist in preparing executive briefings, response letters, and talking points for leadership regarding sensitive provider matters
• Assist with preparation and participation in weekly meetings with Operations, COO, and Compliance teams
• Support relationship-building efforts with OHCA representatives, legislative liaisons, and provider advocacy groups
• Cross-Functional Collaboration & Problem Resolution 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
• Partner with QNXT system administrators and CRM teams to troubleshoot technical issues impacting providers
• Participate in rapid response teams for time-sensitive regulatory or legislative inquiries
• Work closely with the Oklahoma Operations Team to implement permanent remediation strategies and prevent issue recurrence
• Collaborate with Oklahoma-based operational leadership to address systemic challenges and support process improvements
• Process Improvement & Support Analyze escalation trends to identify opportunities for process improvements and proactive interventions
• Support the development and refinement of escalation protocols, service level agreements, and resolution frameworks
• Assist in creating training materials and conducting knowledge-sharing sessions with operational teams to reduce future escalations
• Help implement quality assurance measures to ensure consistency in escalation handling
• Partner with Oklahoma Operations to embed corrective actions into standard workflows
• Reporting & Analytics 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
• Provide insights and recommendations to the Senior Manager based on escalation data analysis

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level