Senior Analyst, Provider Escalations (Associate Manager)

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

Aetna 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 Responsibilities

Escalation Management & Case Ownership

• Support the Senior Manager in serving as a liaison for provider escalations originating from C-suite executives, OHCA, legislative offices, and other high-priority stakeholders
• Assist in overseeing the ABHOK Escalations Mailbox, ensuring all inquiries are acknowledged and responded to within 24 to 48 hours
• Act as backup to the Senior Manager, Provider Escalations, assuming full responsibility for escalation management in their absence
• Independently manage assigned complex, high-visibility cases from intake through resolution, ensuring timely and satisfactory outcomes
• Handle escalated provider issues related to claims processing, roster management, credentialing, payment disputes, and network concerns
• Ensure all case documentation is completed accurately and timely within the PEERS System
• Maintain detailed case documentation and provide regular status updates to the Senior Manager, executive leadership, and external stakeholders
   

Stakeholder Relations & Communication

• Act as a point of contact for providers during critical incidents, demonstrating empathy and professionalism
• Defuse tense situations with dissatisfied providers while protecting organizational interests and maintaining compliance
• Assist in preparing executive briefings, response letters, and talking points for leadership regarding sensitive provider matters
• Assist with preparation and participation in weekly meetings with Operations, COO, and Compliance teams
• Support relationship-building efforts with OHCA representatives, legislative liaisons, and provider advocacy groups
   

Cross-Functional Collaboration & Problem Resolution

• Coordinate with Claims, Provider Network, IT, Legal, and Compliance teams to investigate and resolve multi-faceted issues
• Conduct root cause analysis to identify systemic problems and prevent recurring escalations
• Partner with QNXT system administrators and CRM teams to troubleshoot technical issues impacting providers
• Participate in rapid response teams for time-sensitive regulatory or legislative inquiries
• Work closely with the Oklahoma Operations Team to implement permanent remediation strategies and prevent issue recurrence
• Collaborate with Oklahoma-based operational leadership to address systemic challenges and support process improvements
   

Process Improvement & Support

• Analyze escalation trends to identify opportunities for process improvements and proactive interventions
• Support the development and refinement of escalation protocols, service level agreements, and resolution frameworks
• Assist in creating training materials and conducting knowledge-sharing sessions with operational teams to reduce future escalations
• Help implement quality assurance measures to ensure consistency in escalation handling
• Partner with Oklahoma Operations to embed corrective actions into standard workflows
   

Reporting & Analytics

• Generate reports on escalation metrics, resolution times, and recurring themes for senior management review
• Track and monitor key performance indicators related to provider satisfaction and issue resolution
• Provide insights and recommendations to the Senior Manager based on escalation data analysis

Required Qualifications

• Minimum 5-7 years of progressive experience in healthcare operations, provider relations, or managed care
• Minimum 2-3 years in a supervisory or escalation management role handling complex cases
• Proven experience working with Medicaid programs, regulatory agencies, and government stakeholders

Technical Skills

• Required: Advanced proficiency with QNXT claims processing system
• Required: Expert-level knowledge of CRM platforms (Salesforce or similar)
• Strong proficiency with Microsoft Office Suite, particularly Excel for data analysis
• Experience with ticketing/case management systems and reporting tools
• Familiarity with healthcare data systems and electronic health record platforms
   

Healthcare Knowledge

• Comprehensive understanding of Medicaid policies, regulations, and provider reimbursement methodologies
• Knowledge of claims adjudication processes, provider enrollment, and credentialing procedures
• Understanding of roster management and eligibility verification processes
• Familiarity with state and federal healthcare compliance requirements
   

Core Competencies

• Exceptional organizational skills with ability to manage multiple high-priority, time-sensitive issues simultaneously
• Crisis management skills with proven ability to remain calm and solution-focused under pressure
• Strong communication skills – both written and verbal – with ability to translate complex technical issues for diverse audiences
• Emotional intelligence and de-escalation skills to manage difficult conversations with diplomacy and professionalism
• Strong analytical and problem-solving abilities to diagnose root causes and develop comprehensive solutions
• Professional presence with ability to interact confidently with senior leaders and government officials
• Collaborative approach with ability to work effectively across multiple departments
• Detail-oriented mindset with commitment to accuracy and thoroughness in documentation

Preferred Qualifications

• Experience working directly with state health departments or Medicaid agencies
• Master's degree preferred
• Prior exposure to legislative inquiries or constituent services

Education

• Bachelor's degree in Healthcare Administration, Business Administration, or equivalent experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $91,800.00

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/12/2026

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