Medicare PDE & Claims Analytics Lead

CVS Health; Mississippi; Hybrid; 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 hiring for a full-time role focused on reviewing claims and PDE (Prescription Drug Event) errors. The analyst will coordinate with the PDE Reporting Team, manage PDE Rejections analyses, and ensure timely, compliant responses to CMS deadlines.

The position requires knowledge of Part D plans and CMS guidance. The role emphasizes liaison work across internal teams, data analysis, and ongoing process improvement, with a strong focus on accuracy and regulatory compliance.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience.
• Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
• Strong organizational skills and ability to manage multiple projects simultaneously.
• Proficiency with Word and Excel; SQL and Python skills.
• Bachelor's degree preferred or equivalent work experience.

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 to ensure timely resolution of PDE Rejections.
• Coordinate research with various departments and submit responses to external clients or Acumen per CMS deadlines.
• Assist with weekly PDE meetings.
• Improve Medicare claims data through root cause and impact analysis of errors.

Skills

Communication skills

Organizational skills

Time management

Attention to detail

Education

Bachelor's degree preferred or equivalent work experience

Tools

Microsoft Word

Excel

SQL

Python

Job description

CVS Health is hiring for a full-time role focused on reviewing claims and PDE (Prescription Drug Event) errors. The analyst will coordinate with the PDE Reporting Team, manage PDE Rejections analyses, and ensure timely, compliant responses to CMS deadlines.

The position requires knowledge of Part D plans and CMS guidance. The role emphasizes liaison work across internal teams, data analysis, and ongoing process improvement, with a strong focus on accuracy and regulatory compliance.