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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Provider File Specialist - Remote
- 💼
- EmblemHealth
- 📅
- Jul 02, 2026 Post Date
Summary of Job
Conduct vendor performance auditing and support maintenance of provider data integrity across core operational processes. Ensure adherence to contractual requirements, regulatory expectations, and customer experience standards through routine audits and follow-up. Contribute to analytics and continuous improvement initiatives by compiling data, tracking results, and escalating issues as needed. Compile and share data quality and workflow findings with business partners; track follow-ups and escalate issues as needed.
Responsibilities
- Audit vendor performance for each core process to help ensure contractual requirements are met and results align with EmblemHealth customer experience objectives.
- Perform routine transactional reviews, audits, and compliance checks for vendor-supported processes; document results and escalate trends or issues to leadership.
- Resolve day-to-day operational issues by researching root causes, coordinating with business partners and vendors, and documenting outcomes; escalate higher-risk issues and recommend enhancements to management for prioritization and execution.
- Maintain audit and assessment records; document findings, variances, and supporting evidence; and escalate results to management for analysis and development of corrective actions.
- Complete project activities and contribute knowledge within project teams and workgroups aligned with department initiatives.
- Share process knowledge and best practices with peers and new team members as requested.
- Participate in cross-functional and vendor related projects as assigned.
- Perform other duties as directed, assigned, or required.
Qualifications
- Bachelor’s degree
- 2 – 3+ 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)
- Strong collaboration skills and the ability to communicate effectively with stakeholders (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.