Analyst – Medicaid Network Operations

Job not on LinkedIn

🕒 July 30

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🌐 Network Operations

🚫👨‍🎓 No degree required

👻 Ghost score 26%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review incoming contractual documents for completeness and accuracy and obtain missing or incomplete documents • Load newly contracted providers to the provider record database • Audit updated provider records and submit corrections as needed • Maintain the repository of participating provider contracts and load newly executed agreements • Manage the contracting team email box and triage internal and external messages • Research and respond to provider and internal staff inquiries regarding contractual matters and network participation • Send provider welcome packets to newly contracted providers • Support internal contract auditing processes • Compile, summarize, and report on health plan compliance with contract submission rules and exception requests at least monthly • Assist with claims projects, audits, and contract and plan document reviews • Ensure compliance with health plan, corporate, state, and federal regulations • Escalate issues to management as needed • Identify process improvement opportunities with Network Development and internal departments • Perform other duties as assigned

🎯 Requirements

• 2-5 years of professional work experience • 1 year in the healthcare industry • Experience working in TriZetto QNXT • Experience with medical terminology • Experience working with Microsoft Office Suite • 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 • GED required • SQL Database Queries • Intermediate Microsoft Excel skills (Excel formulas and pivot tables) • Business reporting

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay range • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility