Medicare Claims & PDE Analyst

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

Job summary

CVS Health is seeking aClaims Analyst to review PDE errors and coordinate resolutions with internal teams and external clients. You will analyze PDE rejections, participate in weekly PDE meetings, and help ensure CMS deadlines are met. The role requires familiarity with Part D plans and government-regulated health programs.

Strong communication, organizational skills, and proficiency with SQL/Python will support successful collaboration across departments and external partners.

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 abilities.

Responsibilities

• Review claims and PDE errors.
• Analyze PDE Rejections reports and distribute analyses to clients.
• Coordinate research with departments and respond to external clients or Acumen.
• Assist with weekly PDE meetings and CMS deadlines.
• Identify root causes and recommend system/process enhancements.

Skills

Government health programs experience

Financial operations

Communication skills

Education

Bachelor's degree or equivalent

Tools

SQL

Python

Job description

CVS Health is seeking aClaims Analyst to review PDE errors and coordinate resolutions with internal teams and external clients. You will analyze PDE rejections, participate in weekly PDE meetings, and help ensure CMS deadlines are met. The role requires familiarity with Part D plans and government-regulated health programs.

Strong communication, organizational skills, and proficiency with SQL/Python will support successful collaboration across departments and external partners.