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
The Senior Analyst, Network Relations is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff are responsible for timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System. Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner. Staff may be responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas.
- Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution.
- Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
- Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate.
- Oversees Access & Availability monthly monitoring process.
- Responsible for reviewing claims data in QNXT when provider’s inquiry involves claims payment adjudication.
- Excellent written and verbal communication skills.
- Conducts or participates in special projects and other duties as assigned.
Required Qualifications
- A minimum of 2-4 years of experience in healthcare operations, provider services, claims support, or payer-related administrative roles.
- Working knowledge of healthcare claims processes, provider data management, and payer-provider interactions.
- Strong attention to detail with the ability to validate provider data accurately.
- Ability to manage multiple requests concurrently while meeting service-level expectations.
- Strong written communication skills and ability to document work clearly and accurately.
- Experience in Medical Terminology, CPT, ICD-10 codes, etc.
- Experience working with the MS Office suite.
- Other duties as assigned
- Must reside in the state of Illinois
Preferred Qualifications
- Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
- Strongly prefer the candidate resides in southern region of Illinois
- Experience in Medical Terminology, CPT, ICD-10 codes, etc.
- Experience using CRM systems, email ticketing tools, and healthcare administrative platforms.
Education
- High school diploma or equivalent required; Bachelor's degree preferred or a combination of professional work experience and education.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $112,200.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Minimum 2-4 years of experience in healthcare operations or related roles
- Working knowledge of healthcare claims processes and provider data management
- Strong attention to detail to validate provider data
- Strong written communication skills
- Experience in Medical Terminology, CPT, ICD-10 codes
- Experience with MS Office suite
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
