Manager - Provider Network Relations

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.POSITION SUMMARYThis position is fully dedicated to GLOBAL VIP CLIENT. The ideal candidate will assist the Senior Network Manager in managing competitive and complex contractual relationships with TPAs and business partners in Africa,. This role supports the international network, medical cost management, and overall claim/customer service experience. The candidate will provide concierge-level service to GLOBAL VIP CLIENT members by ensuring timely network access and proactive management of network relationships for seamless direct settlement access. Additionally, the candidate will assist with day-to-day network operations and act as a liaison between external vendors and internal team members.

*Preference is for this person to reside within the Eastern Time Zone

JOB RESPONSIBILITIES:

• Play a critical role via assisting in setting up 3 -5 direct TPAs setup for GLOBAL VIP CLIENT in next 12 months' time frame.
• Assist Sr. Network manager to manage assigned TPAs via managing day to day operational issues with TPA for GLOBAL VIP CLIENT and work on a resolution of such issues.
• Primary responsible for driving GLOBAL VIP CLIENT nominations and work with TPA to add those providers In-Network. Manage overall responsibilities of provider nomination process for GLOBAL VIP CLIENT.
• Manage network contracting with assigned TPA(s) including addition & suspension of provider.
• Assist with Third Party Risk Governance process for your assigned TPA(s).Oversee, audit, and process primary TPA invoices; review and address disputed items as necessary.
• If any, support manage contracting/maintenance of individual direct providers
• Manage escalated Issues - GOP, Proof of Payment, Provider suspension, Immediate client Issue resolution with TPA & Provider
• If a GOP is issued but the facility does not accept it, contact the TPA or Provider immediately for a swift resolution.
• Assist Network manager in ensuring service level adherence (GOP TAT, eligibility processing, claim TAT, reconciliation TAT, fee invoicing etc)
• Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems.
• Ensure TPA guides, country guides and other internal materials are timely updated and up to date.
• Ensuring streamline GLOBAL VIP CLIENT experience at each country level. Work with account management and TPA to resolve ongoing operational issues.
• End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions.
• Serve as a subject matter expert to assist the internal GLOBAL VIP CLIENT account management team with network and TPA questions or inquiries. Provide support to peers and colleagues working on GLOBAL VIP CLIENT business.

• 2+ years of International Network Management/Operations - service management experience
• 2+ years of International Vendor management experience
• 2+ years of Operations Management (Claim, Customer Service)
• Must possess a successful track record to oversee and manage multiple operational and provider issues and work towards swift resolution.
• Strong project management skills
• Excellent written and verbal communication skills
• Ability to leverage technology to achieve quality and cost efficiencies
• Prior client facing experience
• International travel required - up to 25%
• Benefits Management/Interacting with Medical Professionals

• Additional spoken languages are preferred
• Leadership/Fostering a Global Perspective
• Health Insurance understanding / business negotiations
• Service/Demonstrating Service Discipline

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.