Medicare PDE and Claims Analytics Specialist

CVS Health; Yuma (AZ); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a Claims Analyst to review PDE errors and coordinate resolution with internal teams and external clients. This role requires working knowledge of Part D plans and CMS guidance, with a focus on timely, accurate data processing and reporting.

You will analyze PDE rejections, participate in weekly PDE meetings, and drive continuous improvement in Medicare claims data through root cause analysis and collaboration with cross-functional teams.

Qualifications

• Excellent written and verbal communication skills.
• Strong organizational skills and ability to manage multiple projects.
• Excellent time management skills due to time-sensitive requests.
• Proficiency with Microsoft Word and Excel.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze and distribute PDE Rejections reports to internal and external clients.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Coordinate research with departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and meetings logistics.
• Improve Medicare claims data through root cause and impact analysis of errors; suggest system/procedure enhancements.

Skills

Communication skills

Organizational skills

Time management

Analytical thinking

Education

Bachelor's degree or equivalent

Tools

SQL

Python

Job description

CVS Health is seeking a Claims Analyst to review PDE errors and coordinate resolution with internal teams and external clients. This role requires working knowledge of Part D plans and CMS guidance, with a focus on timely, accurate data processing and reporting.

You will analyze PDE rejections, participate in weekly PDE meetings, and drive continuous improvement in Medicare claims data through root cause analysis and collaboration with cross-functional teams.