Medicare PDE Claims Analyst & Data Quality Lead

CVS Health; East Windsor Hill (CT); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligible

Performance incentives

Job summary

CVS Health is seeking a claims analyst to review PDE errors and coordinate responses across departments to ensure timely, accurate resolutions. You will analyze PDE rejections, coordinate with CMS guidelines, and participate in weekly PDE meetings.

Applicants should have ~3 years of experience with government-regulated health programs and a Bachelor's degree or equivalent work experience. Full-time with a comprehensive benefits package and bonus eligibility.

Qualifications

• ~3 years minimum experience with government-regulated health programs within financial operations and/or related experience.

Responsibilities

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

Skills

Communication

Organization

Time management

SQL

Python

Education

Bachelor's degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a claims analyst to review PDE errors and coordinate responses across departments to ensure timely, accurate resolutions. You will analyze PDE rejections, coordinate with CMS guidelines, and participate in weekly PDE meetings.

Applicants should have ~3 years of experience with government-regulated health programs and a Bachelor's degree or equivalent work experience. Full-time with a comprehensive benefits package and bonus eligibility.