Medicare Claims & PDE Analytics Specialist

CVS Health; Sacramento (CA); 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

Job summary

CVS Health is seeking a claims reviewer to analyze PDE errors and coordinate resolutions with internal teams and external clients. You will manage PDE rejection analysis and ensure timely CMS-compliant responses, including review of Acumen Outliers and weekly PDE meetings.

The role emphasizes strong analytics, industry knowledge of Part D plans, and compliance with CMS guidance. Full-time in California with comprehensive benefits.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations.
• Experience with Medicaid, Medicare, and/or Exchanges preferred.
• Bachelor's degree preferred or equivalent work experience.

Responsibilities

• Review claims and PDE errors and analyze PDE rejections to drive resolution.
• Liaise between PDE Reporting Team, PDE Eligibility/Reconciliation and other entities.
• Coordinate research and submit responses to external clients or Acumen per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare data.

Skills

SQL

Python

Excel

Communication skills

Education

Bachelor's degree or equivalent

Tools

Microsoft Word

Excel

Job description

CVS Health is seeking a claims reviewer to analyze PDE errors and coordinate resolutions with internal teams and external clients. You will manage PDE rejection analysis and ensure timely CMS-compliant responses, including review of Acumen Outliers and weekly PDE meetings.

The role emphasizes strong analytics, industry knowledge of Part D plans, and compliance with CMS guidance. Full-time in California with comprehensive benefits.