Medicare PDE & Claims Analyst

CVS Health; Williamstown (NJ); 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

Wellness programs

Job summary

CVS Health is seeking a Medicare PDE Claims Reviewer to analyze and resolve PDE rejections, coordinating with the PDE Reporting Team and CMS deadlines to ensure timely and accurate resolutions.

The role requires working knowledge of Part D plans and CMS guidance, with an emphasis on process improvement, data review, and collaboration across departments. Strong communication and organizational skills are essential in this full-time position.

Qualifications

• Minimum ~3 years experience with government-regulated health programs in financial operations or related areas.
• Bachelor's degree preferred or equivalent work experience.
• Excellent written and verbal communication with clients and partners.

Responsibilities

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

Skills

Communication skills

Time management

Organizational skills

Attention to detail

Education

Bachelor's degree

Tools

Microsoft Word

Excel

SQL

Python

Job description

CVS Health is seeking a Medicare PDE Claims Reviewer to analyze and resolve PDE rejections, coordinating with the PDE Reporting Team and CMS deadlines to ensure timely and accurate resolutions.

The role requires working knowledge of Part D plans and CMS guidance, with an emphasis on process improvement, data review, and collaboration across departments. Strong communication and organizational skills are essential in this full-time position.