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Senior Provider File Specialist - Remote

EmblemHealth

Mar 12, 2026
Summary of Job Provide advanced oversight of vendor performance and provider data integrity across core operational processes. Ensure adherence to contractual requirements, regulatory expectations and customer experience standards. Lead analytics, drive continuous improvement initiatives and contribute subject matter expertise to cross-functional projects. Partner with key business areas to identify risks, enhance workflow efficiency, and strengthen data quality. Responsibilities Assess and monitor performance of vendors for each core process to ensure contractual requirements are met and that results align with EmblemHealth customer experience objectives. Conduct reviews, transactional audits, compliance checks and operational procedure assessments for all vendor-supported processes. Analyze performance data to compare intended versus actual outcomes, evaluate quality controls, and identify system or process gaps. Monitor and drive policy, procedure and reference tool creation and maintenance. Communicate findings through SAS-based reports, executive presentations, and detailed performance summaries. Drive key project activities and contribute subject-matter expertise within project teams and strategic workgroups aligned with enterprise initiatives. Provide guidance and mentorship to Provider File Specialists, supporting skill development, knowledge growth, and process proficiency. Work collaboratively with business partners to identify operational risks, communicate opportunities for improvement and drive process enhancements. Maintain meticulous audit and assessment records, perform trend analyses against historical baselines, and document variation events and corrective actions. Participate in cross-functional and vendor related projects as assigned. Perform other duties as directed, assigned, or required. Qualifications Bachelor's degree from an accredited four-year college. 4 - 6+ years of relevant, professional work experience including auditing and assessment activities (Required) Additional years of related experience/specialized training may be considered in lieu of degree requirements (Required) Excellent collaboration skills and the ability to influence management decisions (Required) Strong auditing skills that can be applied across all types of business problems (Required) Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required) Ability to organize, prioritize, and successfully manage multiple competing tasks/projects simultaneously (Required) Previous Provider File or equivalent experience (Required) Proficient in MS Office - Word, Excel, Access, PowerPoint, Outlook, Teams, SharePoint, etc. (Required) Additional Information Requisition ID: 1000003007 Hiring Range: $56,160 - $99,360