Senior Analyst – Medicare Claims & PDE Analytics

CVS Health; Tennessee; Hybrid; USD 47,000 - 112,000; Full time

Job summary

CVS Health seeks a claims and PDE analyst to review PDE errors, analyze rejections, and ensure timely resolution for internal and external clients. The role coordinates with the PDE Reporting Team, PDE Eligibility/Reconciliation, and CMS-aligned partners to meet deadlines.

Ideal candidates bring 3+ years in government-regulated health programs within financial operations, strong communication, and proficiency in Excel, SQL, and Python to drive data-driven improvements in Medicare claims data.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations.
• Bachelor’s degree preferred or equivalent work experience.
• Experience with CMS guidance and Part D plans preferred.

Responsibilities

• Review claims and PDE errors and analyze PDE rejections.
• Coordinate research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all related entities.
• Rely on business knowledge to plan and accomplish goals and suggest system/procedure enhancements.

Skills

Communication skills

Time management

Organizational skills

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Word

Microsoft Excel

SQL

Python

Job description

CVS Health seeks a claims and PDE analyst to review PDE errors, analyze rejections, and ensure timely resolution for internal and external clients. The role coordinates with the PDE Reporting Team, PDE Eligibility/Reconciliation, and CMS-aligned partners to meet deadlines.

Ideal candidates bring 3+ years in government-regulated health programs within financial operations, strong communication, and proficiency in Excel, SQL, and Python to drive data-driven improvements in Medicare claims data.