Medicare PDE & Claims Analytics Specialist

CVS Health; Clayton (NC); Presencial; USD 47.000 - 112.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, vision coverage

Paid time off

Retirement savings options

Descripción de la vacante

CVS Health is seeking a claims reviewer to analyze PDE errors, coordinate research with multiple departments, and communicate findings to clients and CMS regulators. You will support the PDE Reporting Team and Eligibility/Reconciliation groups to ensure timely, accurate resolutions.

The role requires strong data skills and knowledge of Part D plans. You will participate in weekly PDE meetings, suggest system and process enhancements, and uphold CMS guidance while serving internal and external

Formación

• ~3 years minimum experience with government-regulated health programs.
• Excellent written and verbal communication skills.
• Proficiency with SQL and/or Python.
• Proficiency with Microsoft Word and Excel.

Responsabilidades

• Review claims and PDE errors and analyze PDE Rejections.
• Serve as liaison between PDE Reporting Team and stakeholders to ensure timely resolution.
• Coordinate research with departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive improvements in Medicare claims data quality.
• Ensure compliance with CMS guidance and maintain knowledge of Part D plans.

Conocimientos

SQL

Python

Excel

Communication

Time management

Educación

Bachelor's degree

Herramientas

Microsoft Word

Microsoft Excel

Descripción del empleo

CVS Health is seeking a claims reviewer to analyze PDE errors, coordinate research with multiple departments, and communicate findings to clients and CMS regulators. You will support the PDE Reporting Team and Eligibility/Reconciliation groups to ensure timely, accurate resolutions.

The role requires strong data skills and knowledge of Part D plans. You will participate in weekly PDE meetings, suggest system and process enhancements, and uphold CMS guidance while serving internal and external