Senior Medicare Claims & Data Analyst

CVS Health; Portland (ME); 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

Bonus/short-term incentive program

Job summary

CVS Health is seeking a claims and PDE reviewer to analyze PDE rejections and support error resolution. You will coordinate with the PDE Reporting Team and other departments to meet CMS deadlines and ensure accurate Medicare claims data.

Responsibilities include attending weekly PDE meetings, reviewing Acumen Outliers, and providing guidance to internal and external clients. Strong communication and organization are essential.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Bachelor’s degree preferred or equivalent work experience required.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections.
• Coordinate research across departments and respond to external clients or Acumen per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data.
• Liaise between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities to ensure timely resolution of PDE Rejections.

Skills

Experience with government-regulated健康

Communication skills

Organizational skills

Time management

MS Word

Excel

SQL

Python

Education

Bachelor’s degree or equivalent work experience

Job description

CVS Health is seeking a claims and PDE reviewer to analyze PDE rejections and support error resolution. You will coordinate with the PDE Reporting Team and other departments to meet CMS deadlines and ensure accurate Medicare claims data.

Responsibilities include attending weekly PDE meetings, reviewing Acumen Outliers, and providing guidance to internal and external clients. Strong communication and organization are essential.