Provider Operations Analyst II – Health Plan, Provider Data Experience

CareSource

. Assimilate large quantities and/or complicated data into meaningful formats for tracking and status requirements .

Posted 10/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $62,700 - $100,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in data analysis, provider relations, and operational processes within healthcare, with a strong focus on compliance and quality metrics. Proficient in SQL and advanced MS Excel, capable of managing multiple initiatives and collaborating cross-functionally.

Highest-signal resume keywords

Data AnalysisProvider RelationsSQL/Access CapabilitiesAdvanced MS ExcelClaims Systems Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisSQLAccessAdvanced MS ExcelPowerPointWordProvider Systems KnowledgeProcess ImprovementWorkflow UnderstandingRoot Cause Analysis

Soft Skills

Organizational SkillsCollaborationCommunicationFacilitationCritical Thinking

Tools & Technologies

FacetsChoreo/Contract ManagerCactus

Industry Keywords

HealthcareManaged CareProvider DataCredentialingContractingPended ClaimsOperational ExcellenceRegulatory ComplianceQuality MetricsSpecial Projects

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Assimilate large quantities and/or complicated data into meaningful formats for tracking and status requirements
Develop queries to identify and quantify provider data issues and assist with resolution plans
Provide analysis and oversight for provider data, workflows, and processes across Contracting, Credentialing, Data Load, Directories, and Pended Claims operations
Act as SME/Business Analyst/Data Analyst for Provider Operations initiatives and special projects
Work cross-functionally with Claims, Configuration, Market Representatives, and Provider Operations
Identify, develop, and implement reporting and business processes supporting data quality, operational excellence, regulatory, and compliance requirements
Develop and monitor daily staff quality and productivity metrics and recommend changes
Manage root cause analysis for high-level escalations requiring intensive research and resolution
Manage special projects involving high-dollar unpaid claims, state complaints, provider service risks, or compliance risks through resolution
Develop, document, and perform testing and validation for process and system changes
Serve as primary contact for vendors and business partners exchanging CareSource provider data
Submit operational workflow requests to update provider data
Collaborate with Talent Development to develop and present training modules
Perform other duties as requested

Requirements

What you’ll need

Bachelor’s Degree or equivalent years of relevant work experience is required
A minimum of three (3) years of health care or managed care experience is required
Experience working on Claims systems, preferably Facets, preferred
Experience in provider relations, contracting, onboarding, credentialing, directories, pended claims, or configuration is highly preferred
Knowledge and understanding of one or more provider systems, including Choreo/Contract Manager, Cactus and Facets
SQL/Access capabilities
Advanced MS Excel, PowerPoint, and Word skills
Proficient in data analysis
Ability to understand workflows and process improvement
Excellent organizational, collaboration, communication, facilitation, and presentation skills
Critical listening, thinking, and problem resolution skills
Ability to manage multiple initiatives and prioritize goals
None required for licensure and certification
May be required to travel, estimated at less than 10%

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Equal Opportunity Employer environment fostering belonging and support for individuals of all backgrounds