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.