Provider Network Operations Data Analyst

Position Overview

The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong relationships between the health plan and its contracted and non-contracted providers across Medicaid, Medicare, and Exchange products.

Work Arrangement: Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location.

Key Responsibilities

• Serve as a primary point of contact for providers, ensuring timely resolution of inquiries and issues.
• Communicate plan policies, procedures, and regulatory updates clearly and professionally.
• Maintain and monitor provider data to ensure accuracy across all systems.
• Review and process provider data intake forms for completeness.
• Track and document provider data changes to ensure timely updates and compliance with turnaround standards.
• Escalate discrepancies or requests that conflict with business processes or contract terms.
• Ensure timely and accurate management of provider contracts, including terms and reimbursement details.
• Investigate and respond to member complaints within established timelines.
• Identify and report compliance issues in accordance with plan policies and procedures.
• Collaborate with internal departments to manage medical costs and support strategic initiatives.
• Demonstrate working knowledge of Facets, particularly the provider database, and consistently communicate updates to the provider maintenance department.

Required Qualifications

• Bachelor’s degree or equivalent work experience required.
• At least one year of experience working with healthcare providers and provider relations.
• Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
• Strong analytical skills (non-IT focused).

Preferred Qualifications

• 3 years of experience in managed care or health insurance preferred.