Senior Analyst, Provider Relations MAPL Focus (Metro NY)
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. 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.
Requirements
- 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
Nice To Haves
- 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
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
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
