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, provi