Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Senior Provider File Specialist - Remote
- 💼
- EmblemHealth
- 📅
- Mar 11, 2026 Post Date
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)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.