This job has closed.

CVS Health · 2 months ago

Sr. Manager, Claims Intake/Sr. Technical Analyst, Medicaid Intake Operations

United States

Full-time

Remote

Mid, Senior Level

$75K/yr - $166K/yr

5+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. They are seeking a dynamic Technical Analyst for the Medicaid Intake Operations Team, responsible for ensuring the accuracy of Electronic Data Interchange (EDI) and claims intake processes, while providing expert support and analyzing large datasets.

Health CareMedicalPharmaceuticalRetailSales

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

Qualification

SQLEDI transactionsClaims operationsData analysisProcess improvementAnalytical skillsDocumentation skillsCommunication skillsProblem-solving skillsCritical thinkingSelf-starterFlexibility

Required

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

Experience with all phases of evaluation studies, including research design, data quality assessment, descriptive analytics, and controlling for covariates

Strong documentation skills; writes readable and reproducible code

Process improvement mindset; strives to simplify complex processes

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

Bachelor's degree or equivalent in Information Systems, Computer Science, or a related field; or equivalent combination of education and experience

Preferred

Advanced Excel skills (pivots, formulas, V-lookup)

2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s)

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

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