Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
This position is responsible for reviewing claims and PDE (Prescription Drug Event) errors. This includes analyzing and distributing the PDE Rejections reports and analysis to internal and external clients. The position will serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all entities involved directly or indirectly with PDE to ensure timely and accurate resolution of PDE Rejections. Download and review the Acumen Outliers. Coordinate the research with various departments and submit the responses to external clients or Acumen according to CMS deadlines. Assist with the weekly PDE meetings. Ensure continuous improvement of Medicare claims data through root cause and impact analysis of errors, recommendations for systems and procedure enhancements. The position will rely upon business knowledge, including industry concepts and practices, technical skills, and prior experience to plan and accomplish goals. Candidate should have working knowledge of Part D plans and be able to study and correctly interpret CMS Guidance. This position is also responsible for review of guidance and being compliant with CMS.

Required Qualifications

• 5+ years' experience as a Claims Analyst, Data Analyst, Internal Auditor, and/or Business Analyst.
• 1+ years of experience with Medicare Part D.

Education

• Bachelor's degree or equivalent work experience required

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/16/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.