Medicare Claims & PDE Analyst | Data-Driven & Impactful

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

Job summary

CVS Health is seeking a detail‑oriented analyst to review claims and PDE (Prescription Drug Event) errors. You will analyze PDE Rejections, coordinate with multiple departments, and ensure timely CMS‑compliant responses to external clients.

Ideal candidates have 3+ years in government-regulated health programs, strong communication, and proficiency with Excel, Word, SQL, and/or Python. This full‑time role offers comprehensive benefits and is based in Missouri.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections.
• Coordinate research with various departments and submit responses to external clients or Acumen per CMS deadlines.
• Assist with the weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and other entities involved with PDE.

Skills

SQL

Python

Excel

Word

Education

Bachelor's degree preferred or equivalent work experience

Job description

CVS Health is seeking a detail‑oriented analyst to review claims and PDE (Prescription Drug Event) errors. You will analyze PDE Rejections, coordinate with multiple departments, and ensure timely CMS‑compliant responses to external clients.

Ideal candidates have 3+ years in government-regulated health programs, strong communication, and proficiency with Excel, Word, SQL, and/or Python. This full‑time role offers comprehensive benefits and is based in Missouri.