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Senior Manager, Claims Technical Analyst, Medicaid Intake Operations

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Work at Home, Arizona

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Category:
IT - Administration

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Contract Type:
Not provided

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Salary:

75400.00 - 165954.00 USD / Year
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Job Description:

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.

Job Responsibility:

  • 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

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
  • Bachelor’s degree or equivalent work experience

Nice to have:

  • Advanced Excel skills (pivots, formulas, V-lookup)
  • 2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s)
What we offer:
  • 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
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

Additional Information:

Job Posted:
March 04, 2026

Expiration:
March 06, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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