Medicare Claims & PDE Analyst

CVS Health; Eagle (ID); On-site; 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

Bonus eligibility

Job summary

CVS Health is seeking a claims analyst to review PDE errors and manage PDE rejection analyses. You will coordinate with the PDE Reporting Team and other departments to ensure timely resolution and CMS-compliant responses. The role requires knowledge of Part D and CMS guidance.

The position offers full-time employment with comprehensive benefits, including medical/dental/vision, PTO, retirement options, and performance bonuses. Strong Excel and SQL/Python skills are preferred.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience.
• Excellent written and verbal communication skills.
• Strong organizational and time management skills.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

Responsibilities

• Review claims and PDE errors and analyze PDE rejections.
• Coordinate research with various departments and respond to external clients or Acumen according to CMS deadlines.
• Assist with the weekly PDE meetings.
• Improve Medicare claims data through root cause and impact analysis of errors and recommend system/process enhancements.

Skills

Excellent communication

Strong organizational skills

Time management

Education

Bachelor's degree preferred or equivalent work experience

Tools

SQL

Python

Microsoft Word/Excel

Job description

CVS Health is seeking a claims analyst to review PDE errors and manage PDE rejection analyses. You will coordinate with the PDE Reporting Team and other departments to ensure timely resolution and CMS-compliant responses. The role requires knowledge of Part D and CMS guidance.

The position offers full-time employment with comprehensive benefits, including medical/dental/vision, PTO, retirement options, and performance bonuses. Strong Excel and SQL/Python skills are preferred.