Senior Analyst, Provider Relations MAPL Focus (Metro NY

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.

• 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

• 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

• 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