Senior PDE & Medicare Claims Analyst

CVS Health; Springfield (IL); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a detail-oriented professional to review and analyze PDE errors, coordinating responses with internal teams and external clients. The role supports Medicare data quality and CMS guidance compliance.

The successful candidate will leverage SQL/Python and Excel skills, manage multiple projects, and communicate effectively with government agencies and clients. A Bachelor's degree or equivalent experience is preferred for this full-time role.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience.
• Experience with Medicaid, Medicare, and/or Exchanges.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.
• Bachelor's degree or equivalent work experience preferred.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections." ,
• Distribute PDE Rejections reports to internal and external clients and act as liaison among PDE teams and other entities.
• Coordinate research with various departments and respond to external clients per CMS deadlines.
• Assist in weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.

Skills

Excellent communication

Strong organizational skills

Time management

Attention to detail

Education

Bachelor's degree or equivalent

Tools

SQL

Python

Microsoft Word

Excel

Job description

CVS Health is seeking a detail-oriented professional to review and analyze PDE errors, coordinating responses with internal teams and external clients. The role supports Medicare data quality and CMS guidance compliance.

The successful candidate will leverage SQL/Python and Excel skills, manage multiple projects, and communicate effectively with government agencies and clients. A Bachelor's degree or equivalent experience is preferred for this full-time role.