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
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
- 3 years minimum experience with government-regulated health programs (Medicaid, Medicare, and/or Exchanges).
Preferred Qualifications
- Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
- Strong organizational skills and ability to manage multiple projects simultaneously.
- Excellent time management skills as these requests are time sensitive.
- Proficiency with Microsoft Word and Excel.
- Proficiency with SQL and/or Python.
Education
- Bachelor's degree preferred or equivalent work experience required
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $122,400.00This 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: 03/07/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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