Medicare Claims & PDE Analyst

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

Job summary

CVS Health is seeking a dedicated Claims Reviewer to oversee PDE errors and rejection analyses. The role coordinates with the PDE Reporting Team, Eligibility/Reconciliation, and other departments to ensure timely, accurate resolutions in line with CMS guidance.

Experience with Part D and government programs is essential. The position emphasizes strong communication, organization, and the ability to manage multiple tasks under tight CMS deadlines while contributing to improvements in Medicare

Qualifications

• 3 years minimum experience with government-regulated health programs in financial operations or related experience.
• Experience with Medicaid, Medicare, and/or Exchanges.
• Excellent written and verbal communication with clients and internal partners.
• Strong organizational skills and ability to manage multiple projects simultaneously.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.
• Bachelor's degree preferred or equivalent work experience required.

Responsibilities

• Review claims and PDE errors and analyze PDE rejections.
• Distribute PDE Rejections reports to internal and external clients.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation, and related departments.
• Review Acumen Outliers and coordinate research with internal teams.
• Ensure responses to CMS deadlines and assist weekly PDE meetings.
• Contribute to continuous improvement of Medicare claims data through root cause and impact analysis.

Skills

Communication skills

Time management

Organizational skills

MS Word

MS Excel

SQL

Python

Education

Bachelor's degree or equivalent

Job description

CVS Health is seeking a dedicated Claims Reviewer to oversee PDE errors and rejection analyses. The role coordinates with the PDE Reporting Team, Eligibility/Reconciliation, and other departments to ensure timely, accurate resolutions in line with CMS guidance.

Experience with Part D and government programs is essential. The position emphasizes strong communication, organization, and the ability to manage multiple tasks under tight CMS deadlines while contributing to improvements in Medicare