Job Details

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 SummaryAetna 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.Key ResponsibilitiesEscalation Management & Case OwnershipSupport the Senior Manager in serving as a liaison for provider escalations originating from C-suite executives, OHCA, legislative offices, and other high-priority stakeholdersAssist in overseeing the ABHOK Escalations Mailbox, ensuring all inquiries are acknowledged and responded to within 24 to 48 hoursAct as backup to the Senior Manager, Provider Escalations, assuming full responsibility for escalation management in their absenceIndependently manage assigned complex, high-visibility cases from intake through resolution, ensuring timely and satisfactory outcomesHandle escalated provider issues related to claims processing, roster management, credentialing, payment disputes, and network concernsEnsure all case documentation is completed accurately and timely within the PEERS SystemMaintain detailed case documentation and provide regular status updates to the Senior Manager, executive leadership, and external stakeholdersStakeholder Relations & CommunicationAct as a point of contact for providers during critical incidents, demonstrating empathy and professionalismDefuse tense situations with dissatisfied providers while protecting organizational interests and maintaining complianceAssist in preparing executive briefings, response letters, and talking points for leadership regarding sensitive provider mattersAssist with preparation and participation in weekly meetings with Operations, COO, and Compliance teamsSupport relationship‑building efforts with OHCA representatives, legislative liaisons, and provider advocacy groupsCross‑Functional Collaboration & Problem ResolutionCoordinate with Claims, Provider Network, IT, Legal, and Compliance teams to investigate and resolve multi‑faceted issuesConduct root cause analysis to identify systemic problems and prevent recurring escalationsPartner with QNXT system administrators and CRM teams to troubleshoot technical issues impacting providersParticipate in rapid response teams for time‑sensitive regulatory or legislative inquiriesWork closely with the Oklahoma Operations Team to implement permanent remediation strategies and prevent issue recurrenceCollaborate with Oklahoma‑based operational leadership to address systemic challenges and support process improvementsProcess Improvement & SupportAnalyze escalation trends to identify opportunities for process improvements and proactive interventionsSupport the development and refinement of escalation protocols, service level agreements, and resolution frameworksAssist in creating training materials and conducting knowledge‑sharing sessions with operational teams to reduce future escalationsHelp implement quality assurance measures to ensure consistency in escalation handlingPartner with Oklahoma Operations to embed corrective actions into standard workflowsReporting & AnalyticsGenerate reports on escalation metrics, resolution times, and recurring themes for senior management reviewTrack and monitor key performance indicators related to provider satisfaction and issue resolutionProvide insights and recommendations to the Senior Manager based on escalation data analysisRequired QualificationsMinimum 5‑7 years of progressive experience in healthcare operations, provider relations, or managed careMinimum 2‑3 years in a supervisory or escalation management role handling complex casesProven experience working with Medicaid programs, regulatory agencies, and government stakeholdersTechnical SkillsAdvanced proficiency with QNXT claims processing systemExpert‑level knowledge of CRM platforms (Salesforce or similar)Strong proficiency with Microsoft Office Suite, particularly Excel for data analysisExperience with ticketing/case management systems and reporting toolsFamiliarity with healthcare data systems and electronic health record platformsHealthcare KnowledgeComprehensive understanding of Medicaid policies, regulations, and provider reimbursement methodologiesKnowledge of claims adjudication processes, provider enrollment, and credentialing proceduresUnderstanding of roster management and eligibility verification processesFamiliarity with state and federal healthcare compliance requirementsCore CompetenciesExceptional organizational skills with ability to manage multiple high‑priority, time‑sensitive issues simultaneouslyCrisis management skills with proven ability to remain calm and solution‑focused under pressureStrong communication skills – both written and verbal – with ability to translate complex technical issues for diverse audiencesEmotional intelligence and de‑escalation skills to manage difficult conversations with diplomacy and professionalismStrong analytical and problem‑solving abilities to diagnose root causes and develop comprehensive solutionsProfessional presence with ability to interact confidently with senior leaders and government officialsCollaborative approach with ability to work effectively across multiple departmentsDetail‑oriented mindset with commitment to accuracy and thoroughness in documentationPreferred QualificationsExperience working directly with state health departments or Medicaid agenciesMaster's degree preferredPrior exposure to legislative inquiries or constituent servicesEducationBachelor's degree in Healthcare Administration, Business Administration, or equivalent experience.Anticipated Weekly Hours40Time TypeFull timePay Range$46,988.00 - $91,800.00This 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.Great Benefits For Great PeopleWe 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.We anticipate the application window for this opening will close on: 04/15/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.#J-18808-Ljbffr