Medicare Claims Data Analyst | PDE Rejections & Insights

CVS Health; Central City (NE); On-site; USD 47,000 - 112,000; Full time

Job summary

CVS Health is seeking a Claims Validation Specialist to review PDE errors and coordinate research with CMS guidance. The role involves analyzing PDE Rejections, distributing reports to internal and external clients, and ensuring timely, compliant resolutions across teams.

You will work with the PDE Reporting Team, Eligibility/Reconciliation, and other stakeholders to drive root-cause analysis and process improvements while meeting CMS deadlines. This is a full-time position in the United States.

Qualifications

• 3 years minimum experience with government-regulated health programs (Medicaid/Medicare/Exchanges).
• Bachelor's degree preferred or equivalent work experience.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze and distribute PDE Rejections reports to internal and external clients.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Coordinate research with multiple departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and data review.
• Drive continuous improvement through root-cause analysis of errors and recommendations for system/process enhancements.

Skills

Communication

Organizational skills

Time management

Microsoft Word

Excel

SQL

Python

Education

Bachelor's degree or equivalent

Tools

SQL

Python

Job description

CVS Health is seeking a Claims Validation Specialist to review PDE errors and coordinate research with CMS guidance. The role involves analyzing PDE Rejections, distributing reports to internal and external clients, and ensuring timely, compliant resolutions across teams.

You will work with the PDE Reporting Team, Eligibility/Reconciliation, and other stakeholders to drive root-cause analysis and process improvements while meeting CMS deadlines. This is a full-time position in the United States.