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CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Senior Analyst, Network Relations
Location
United States
Posted
73 days ago
Salary
$47.0K - $112K / year
Seniority
Senior
No structured requirement data.
Job Description
Senior Analyst, Network Relations
CVS Health
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 Act as a primary resource for all dental products (DHMO, PPO, Medicare) for providers, sales and marketing, and Dental Service Centers to aid in the achievement of Aetna Key Performance Measures. Act as the liaison with the Primary Care Dentists and Specialists in a specific geographic territory responsible for overall maintenance and territory management of the provider network, as a functional subject matter expert, demonstrating a strong understanding of Aetna's Dental Products and market position. Negotiation of contract language and provider compensation. Review quality and service reports with provider and appropriate staff, contacting Dental providers regarding quality reviews conducted where unacceptable results were obtained. Timely response to correspondence from Provider offices, included, but not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues. Documented resolution and follow through communicated to all parties. Presentation of DHMO and PPO plan design, compensation process, claim / encounter submission, and referral policies during new office orientations and reorientations via the telephone Knowledge of the competitive market and Aetna's relevant competitive position, to include member appointment access Presentation of Aetna's electronic capabilities for dental providers to achieve Company goals and targets, promote all EDI initiatives. Required Qualifications - 5 years of Experience such as Sales, Service, Dental Office and/or payor setting. - Strong verbal and written communication skills. Preferred Qualifications - Experience in the dental field and knowledge of PPO, DMO, and Medicare networks. Education Bachelor's degree or relevant experience Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $112,200.00 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: 04/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Senior Phoenix / Ambulatory Application Analyst (Remove Available)
Vanderbilt University Medical CenterBased in Nashville, Tennessee, Vanderbilt University Medical Center (VUMC) is a comprehensive healthcare facility and a leader in medical research, education, a
Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: HealthIT Ambulatory Specialty Job Summary: This Senior Application Analyst position is integral to HealthIT’s ability to meet organizational goals and deliver high quality products to the Transplant Center. This role on the Phoenix Team is responsible for the Transplant lab projects as well as the quality reporting required by UNOS (United Network of Organ Sharing). This position is also responsible for other Ambulatory Clinics such as the Pulmonary (Adult/Peds), Nephrology and the Sleep/PFT clinics. Filing this position is critical to maintain continuity of care and meet our overall strategic priorities for the Transplant Center. The role will support the Phoenix team overall with maintenance and enhancements, support upgrades, participate in on call. Note: This role is available for remote work from most US locations . 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Service Desk Analyst
Gainwell TechnologiesGainwell Technologies is an award-winning digital health technology company that supports the administration of healthcare and human services programs. In past
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Epic PB Analyst
Computer Task Group, IncCTG, a Cegeka company, is at the forefront of digital transformation, providing IT and business solutions that accelerate project momentum and deliver desired value. Over nearly 60 years, we have earned a reputation as a faster and more reliable, results-driven partner. Our vision is to be an indispensable partner to our clients and the preferred career destination for digital and technology experts. CTG leverages the expertise of over 9,000 team members in 19 countries to provide innovative solutions. Together, we operate across the Americas, Europe, and India, working in close cooperation with over 3,000 clients in many of today's highest-growth industries. For more information, visit www.ctg.com . Our culture is a direct result of the people who work at CTG, the values we hold, and the actions we take. In other words, our people define our culture. It's a living, breathing thing that is renewed every day through the ways we engage with each other, our clients, and our communities. Part of our mission is to cultivate a workplace that attracts and develops the best people. CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws. CTG is an Equal Opportunity Employer. CTG will assure equal opportunity and consideration to all applicants and employees in recruitment, selection, placement, training, benefits, compensation, promotion, transfer, and release of individuals without regard to race, creed, religion, color, national origin, sex, sexual orientation, gender identity and gender expression, age, disability, marital or veteran status, citizenship status, or any other discriminatory factors as required by law. CTG is fully committed to promoting employment opportunities for members of protected classes.
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Senior Fraud Strategy Analyst
EarnestAt Earnest, we empower you to take control of your career so you can empower students to take control of their finances.
Earnest empowers ambitious professionals to make confident financial decisions and build the life they envision. Earnies are committed to helping borrowers move forward with confidence by offering smarter borrowing options with a clearer path to taking control of their debt. If you’re as passionate as we are about our mission, read more below, and let’s build something great together. What You'll Do: - Design, develop, and optimize fraud strategies across personal loans and student loan refinance products - Monitor portfolio performance to identify emerging fraud trends, risks, and optimization opportunities - Develop and deploy fraud rules and strategies using segmentation, statistical analysis, and predictive modeling techniques - Own end-to-end fraud mitigation processes, with accountability for fraud loss reduction and performance outcomes - Design and execute A/B tests and champion/challenger frameworks to evaluate strategy effectiveness - Build and maintain scalable analytical frameworks using tools such as Snowflake and dbt - Develop dashboards and reporting (e.g., Looker) to monitor KPIs such as fraud rate, approval rate, and false positives - Generate actionable insights from structured and unstructured datasets, including limited or noisy data environments - Partner with cross-functional teams (Product, Engineering, Risk, Operations) and external vendors to implement fraud solutions - Leverage internal and third-party data to enhance fraud detection capabilities - Continuously evaluate and refine strategies based on performance metrics and evolving fraud patterns - Communicate insights, strategy performance, and model behavior clearly to stakeholders and senior leadership - Support model development lifecycle, including design, validation, and production deployment About You: - Bachelor’s degree in a quantitative field (e.g., Statistics, Engineering, Analytics, Economics); Master’s preferred - 4+ years of experience in fraud risk, credit risk, or customer risk management within a financial institution or fintech - 3+ years of hands-on experience with SQL, Python, or R for data analysis and modeling - 3+ Proven experience designing and implementing fraud strategies for unsecured lending products (e.g., personal loans) - Strong analytical and problem-solving skills with attention to detail - Ability to translate complex data into clear, actionable insights - Effective communicator with experience influencing cross-functional stakeholders - Self-starter with a high degree of ownership, curiosity, and adaptability Even Better: - Experience with machine learning models (e.g., logistic regression, tree-based models, anomaly detection) - Familiarity with fraud typologies (e.g., synthetic identity, first-party fraud, account takeover) - Knowledge of regulatory frameworks and risk controls (e.g., fair lending, model governance) - Experience with experimentation frameworks and decision systems - Exposure to modern data stack tools (e.g., dbt, Snowflake) and BI tools (e.g., Looker) A little about our pay philosophy: We take pride in compensating our employees fairly and equitably. We are showcasing a range of your potential base salary based on the roles location. The successful candidate’s starting pay will also be determined based on job-related qualifications, internal compensation, candidate location and budget. This range may be modified in the future. Pay Range $124,000—$155,000 USD Earnest believes in enabling our employees to live their best lives. We offer a variety of perks and competitive benefits, including: - Health, Dental, & Vision benefits plus savings plans - Mac computers + work-from-home stipend to set up your home office - Monthly internet and phone reimbursement - Employee Stock Purchase Plan - Restricted Stock Units (RSUs) - 401(k) plan to help you save for retirement plus a company match - Robust tuition reimbursement program - $1,000 travel perk on each Earnie-versary to anywhere in the world - Competitive days of annual PTO - Competitive parental leave What Makes an Earnie: At Earnest, our people bring our cultural principles to life. These principles define how we work, how we win, and what we expect of ourselves and each other: - Every Second Counts: Speed is our competitive advantage. Our customers need better solutions, and the faster we execute, the greater our chance of success. - Choose To Do Hard Things: We win by tackling the hard things that others avoid, fueled by grit and resilience. - Pursue Excellence: Great companies, teams, and individuals never settle and are proud of the work that they do. What’s good enough today won’t be good enough tomorrow. Excellence isn’t a destination; it’s a mindset of continuous improvement. - Lead Together: Our success comes from how we work together. Leadership is not about titles—it is about action. We take ownership, drive results, and move forward as a team. - Don’t Take Yourself Too Seriously: We take our work seriously, not ourselves. The stakes are high, but a sense of humor keeps us grounded, creative, and resilient. At Earnest, we are committed to building an environment where our employees feel included, valued, and heard. Our belief is that a strong commitment to diversity, inclusion, equity, and belonging enables us to move forward with our mission. We are dedicated to adding new perspectives to the team and encourage anyone to apply if your experience is close to what we are looking for. Earnest provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity, veteran status, disability or genetics. Qualified applicants with criminal histories will be considered for the position in a manner consistent with the Fair Chance Ordinance.




