Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

• Optimizes interactions with assigned providers and

internal business partners to establish and maintain
productive, professional relationships.
- Monitors service capabilities and collaborates cross-
functionally to ensure that the needs of constituents are
met and that escalated issues related but not limited to,
claims payment, contract interpretation or parameters,
and accuracy of provider contract or demographic
information are resolved.

• Supports or assists with operational activities that may

include, but are not limited to, database management,
and contract coordination.

• Performs credentialing support activities as needed.
• Educates providers as needed to ensure compliance

with contract policies and parameters, plan design,
compensation process, technology, policies, and
procedures.

• Meets with key providers periodically to ensure service

levels are meeting expectations.

• Manages the development of agenda, validates

materials, and facilitates external provider meetings.

• May collaborate cross-functionally on the implementation

of contracts or provider demographic update

Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 130,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
Working knowledge of business segment specific codes,
products, and terminology.

• 3-5 years' experience with business segment specific

policy, benefits, plan design and language.

• Strong verbal and written communication, interpersonal,

problem resolution and critical thinking skills.

• Candidate can reside in IL and/ or OH

Preferred Qualifications
3+ years' experience in business segment environment
servicing providers with exposure to benefits and/or
contract interpretation

3-5 Years Customer Service working with providers

QNXT Systems experience

Education
Bachelors degree or equivalent combination of education
and experience

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.