Senior Manager, Claims Technical Analyst, Medicaid Intake Operations

CVS Health

3d

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 As the Senior Manager, Claims Technical Analyst of the Medicaid Intake Operations Team you will play a critical role in ensuring the accuracy and integrity of all Electronic Data Interchange (EDI) and claims intake processes within the Medicaid line of business. .

Requirements

• 5+ years of experience as a SQL Server power user (coding and developing data extracts).
• 5+ years of data interpretation and analysis experience.
• 5+ years querying large datasets using SQL, SAS, or other data tools.
• Strong documentation skills; writing readable and reproducible code.
• Process improvement mindset; strives to simplify complex processes.
• Proficient in Word, PowerPoint, Excel.
• Experience working independently and prioritizing multiple deliverables.
• Experience managing conflicting priorities and concurrent projects.
• Excellent verbal and written communication skills with experience communicating technical information to non-technical audiences.

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.
• 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

• 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.

What This Job Offers

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