Medicare Claims & PDE Analytics Specialist

CVS Health; Milton (MA); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Claims Analyst to review PDE errors and manage related analyses for Medicare programs. You will serve as a liaison between the PDE Reporting Team and Eligibility/Reconciliation units, ensuring timely resolution and CMS-compliant responses.

The role requires solid technical skills and knowledge of Part D plans. You will coordinate with multiple departments, review outliers, and support continuous improvement initiatives while maintaining accuracy and compliance in a

Qualifications

• ~3 years minimum experience with government-regulated health programs in financial operations or related roles.
• Experience with Medicaid, Medicare, and/or Exchanges is preferred.
• Bachelor’s degree or equivalent work experience is common for this role.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze PDE Rejections reports and distribute analysis to clients.
• Coordinate research with departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare data.

Skills

Communication skills

Organization

Time management

MS Word & Excel

SQL / Python

Education

Bachelor's degree

Job description

CVS Health is seeking a Claims Analyst to review PDE errors and manage related analyses for Medicare programs. You will serve as a liaison between the PDE Reporting Team and Eligibility/Reconciliation units, ensuring timely resolution and CMS-compliant responses.

The role requires solid technical skills and knowledge of Part D plans. You will coordinate with multiple departments, review outliers, and support continuous improvement initiatives while maintaining accuracy and compliance in a