Medicare Claims Data Analyst - PDE Rejections & Insights

CVS Health; Illinois; Hybrid; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a dedicated analytics professional to review Medicare PDE claims, analyze rejections, and coordinate cross-functional responses. The role supports CMS deadlines and drives process improvements across departments.

The ideal candidate has related financial operations experience with government programs, strong communication, and proficiency in Word/Excel, SQL, and Python. Full-time in Illinois with comprehensive benefits.

Qualifications

• Experience with government-regulated health programs (Medicare/Medicaid) within financial operations.
• Bachelor's degree preferred or equivalent work experience.
• Strong written and verbal communication skills.
• Ability to manage multiple projects simultaneously.
• Familiarity with CMS guidance and compliance requirements.

Responsibilities

• Review claims and PDE errors; analyze PDE Rejections.
• Coordinate research with departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings.
• Identify root causes of errors to improve Medicare claims data and drive procedural enhancements.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and other stakeholders.

Skills

Communication skills

Organizational skills

Time management

MS Word proficiency

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Word

Microsoft Excel

SQL

Python

Job description

CVS Health is seeking a dedicated analytics professional to review Medicare PDE claims, analyze rejections, and coordinate cross-functional responses. The role supports CMS deadlines and drives process improvements across departments.

The ideal candidate has related financial operations experience with government programs, strong communication, and proficiency in Word/Excel, SQL, and Python. Full-time in Illinois with comprehensive benefits.