Network Relations, Senior Analyst

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:

Senior Analyst Provider Engagement Network Solutions Team is responsible for managing and resolving provider related inquiries and operational processes to ensure seamless network participation and compliance. This role involves direct interaction with dental providers, and internal teams to maintain accurate provider data, resolve claim issues, and support credentialing and contracting activities.

• Claims Management: Investigate and resolve provider claim issues, ensuring timely and accurate adjudication.
• Provider Data Maintenance: Submitting demographic changes and updates to maintain accurate provider records in all systems.
• Contracting & Agreement Support (PPO only): Handle Complaints grievance and appeals requests, including contract generation and amendments for PPO networks.
• Network Participation Requests: Manage opt-in and opt-out requests for provider participation in various networks.
• Credentialing Coordination: Facilitate credentialing requests and ensure compliance with organizational and regulatory standards.
• Regulatory & Compliance Support: Collaborate with DOI (Department of Insurance) and SIU (Special Investigations Unit) for compliance matters and fraud prevention.
• Provider Education: Deliver guidance and training to providers regarding policies, procedures, and online portal navigation.
• Electronic Payment Setup: Send EFT (Electronic Funds Transfer), ERA (Electronic Remittance Advice), and VCC (Virtual Credit Card) enrollment requests for processing.

Required Qualifications

• Bachelor's degree in dental, healthcare administration, business, or related field (or equivalent experience).
• 5+ years of experience in dental, provider relations, network management, or healthcare operations/administration.
• Strong understanding of PPO networks, credentialing processes, and claims administration.
• Excellent communication and problem-solving skills.
• Proficiency in MS Office and provider management systems.
• Detail-oriented with strong organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Knowledge of regulatory requirements and compliance standards.
• Customer focused with a commitment to service excellence.

Preferred Qualifications
Experience in the dental field and knowledge of PPO, and Medicare networks.

Education Bachelor's degree or relevant experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. 
 

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

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Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.