Mgr, Claims Technical Analyst (Medicaid Intake Operations)

CVS Health

1d • Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Medicaid Intake Operations Team plays a critical role ensuring the accuracy and integrity of all Electronic Data Interchange (EDI) and claims intake processes within the Medicaid line of business. We are seeking a Manager Claim Technical Analyst (Medicaid Intake Operations) with a strong foundation in SQL, EDI transactions, and claims operations. In this role, you will: Serve as the Technical Subject Matter Expert (SME) for intake rules and matching logic. Liaise with providers and internal teams to resolve questions about EDI and Claims Intake rejections. Provide second-level expert support for intake claim rejections. Analyze large datasets for research and troubleshooting. Collaborate with Product Owners and IT teams on system enhancements and fixes. Participate in testing and verification of business rules and validations. Manage multiple projects and tasks simultaneously while maintaining high-quality results. Support Product Owners, Business Owners, and Leads using technical and analytical expertise. Communicate effectively across all levels of the organization, including cross-functional teams. Write complex SQL queries to join multiple data sources and analyze data for root causes, trends, and opportunities. Lead the creation of automated reporting solutions using Tableau, Excel, and other tools to deliver actionable insights. Translate complex data analysis into clear, actionable information for non-technical audiences. Analyze EDI and Claims intake rejections from internal and external inquiries, including provider calls. Track and execute solutions for identified issues. Perform User Acceptance Testing for logic changes and enhancements. Develop utilities, queries, and processes for post-production checkout of business rules and system fixes.

Requirements

• 3–5 years of experience as a SQL Server power user (coding and developing data extracts).
• 5+ years of data interpretation and analysis experience.
• 4+ years working with data visualization tools (Tableau, Power BI, or equivalent); expertise in data storytelling and preparing data for presentation in Excel and PowerPoint.
• 5+ years querying large datasets using SQL, SAS, or other data tools.
• Strong documentation skills; writes readable and reproducible code.
• Proficient in Word, PowerPoint, Excel.
• Self-starter with the ability to work independently and prioritize multiple deliverables.
• Demonstrated ability to manage conflicting priorities and concurrent projects.
• Excellent verbal and written communication skills, able to communicate technical ideas to non-technical audiences.
• Strong problem-solving, analytical, and critical thinking skills.

Nice To Haves

• Advanced Excel skills (pivots, formulas, V-lookup).
• 2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s).

Responsibilities

• Serve as the Technical Subject Matter Expert (SME) for intake rules and matching logic.
• Liaise with providers and internal teams to resolve questions about EDI and Claims Intake rejections.
• Provide second-level expert support for intake claim rejections.
• Analyze large datasets for research and troubleshooting.
• Collaborate with Product Owners and IT teams on system enhancements and fixes.
• Participate in testing and verification of business rules and validations.
• Manage multiple projects and tasks simultaneously while maintaining high-quality results.
• Support Product Owners, Business Owners, and Leads using technical and analytical expertise.
• Communicate effectively across all levels of the organization, including cross-functional teams.
• Write complex SQL queries to join multiple data sources and analyze data for root causes, trends, and opportunities.
• Lead the creation of automated reporting solutions using Tableau, Excel, and other tools to deliver actionable insights.
• Translate complex data analysis into clear, actionable information for non-technical audiences.
• Analyze EDI and Claims intake rejections from internal and external inquiries, including provider calls.
• Track and execute solutions for identified issues.
• Perform User Acceptance Testing for logic changes and enhancements.
• Develop utilities, queries, and processes for post-production checkout of business rules and system fixes.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager