Senior Analyst, Network Relations

This is a fully remote position, open to applicants in Texas.

📋 Description

• Investigate and resolve issues related to provider claims to ensure timely and accurate adjudication.

• Submit updates and demographic changes to keep provider records accurate.

• Address PPO complaints, grievances, and appeals, including the generation of contracts and amendments.

• Manage requests for provider network participation, both opt-in and opt-out.

• Facilitate credentialing requests while ensuring compliance with organizational and regulatory standards.

• Collaborate with the Department of Insurance and the Special Investigations Unit on matters of compliance and fraud prevention.

• Offer guidance and training to dental providers regarding policies, procedures, and navigation of the portal.

• Process requests for EFT, ERA, and VCC enrollment.

• Engage directly with dental providers and internal teams to support network participation, maintain provider data accuracy, resolve claims, and handle credentialing and contracting.

⛳️ Requirements

• Bachelor’s degree in dental, healthcare administration, business, or a related field, or equivalent experience.

• Over 5 years of experience in dental, provider relations, network management, or healthcare operations/administration.

• Strong understanding of PPO networks, credentialing processes, and claims administration.

• Exceptional communication and problem-solving abilities.

• Proficient in MS Office and provider management systems.

• Detail-oriented with excellent organizational skills.

• Capability to manage multiple priorities in a dynamic environment.

• Knowledge of regulatory requirements and compliance standards.

• Commitment to customer service excellence.

• Preferred: experience in the dental field and familiarity with PPO and Medicare networks.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive program.