Job Description
Role Description
- The Senior Analyst, Provider Claims Support is responsible for supporting both Network Providers and Internal Business Partners across all aspects of provider-submitted claims. This role assists with claim-related issues identified or reported internally and externally.
- Delivers specific delegated tasks assigned by a supervisor within the Network Management job family.
- Prepares, analyzes, reviews, and projects the financial impact of facility, ancillary, group, and/or behavioral health contracts.
- Drafts contracts and conducts pre-contractual audits and surveys.
- Demonstrates knowledge of contracting processes, contract management, network operations, Medicare fee schedules, financial terms, and performance metrics.
- Completes day-to-day Network Operations tasks with minimal supervision.
- Resolves non-routine issues escalated by more junior team members.
- Supports the execution of operational activities within the Retail Network in alignment with ESI’s work plan and in compliance with requirements for Express Scripts clients and applicable regulatory agencies.
- Supports the facilitation and execution of strategic network initiatives, requiring cross-functional coordination to lead, own, and manage relationships with Network Providers, internal Supply Chain business partners, and client account teams.
- Qualifications
- Bachelor’s degree in a related field, or equivalent relevant work experience (preferred).
- Knowledge of the healthcare and/or PBM industry.
- Strong problem-solving and analytical skills.
- Ability to work cross-functionally to research and resolve complex client and provider issues on a regular basis.
- Ability to manage multiple escalated issues simultaneously under tight timelines.
- Ability to adapt in a dynamic work environment, learn quickly, solve problems, and make decisions with minimal supervision.
- Basic proficiency in Microsoft Office applications, including PowerPoint, email, and spreadsheet software.
- Requirements
- If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
- Benefits
- Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one of employment.
- 401(k) with company match.
- Company paid life insurance.
- Tuition reimbursement.
- A minimum of 18 days of paid time off per year and paid holidays.
- Eligible to participate in an annual bonus plan.
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