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Senior Manager, Claims Technical Analyst, Medicaid Intake Operations

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.<div>Position SummaryAs 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..Primary Duties and Responsibilities<ul><li>Serve as the Technical Subject Matter Expert (SME) for intake rules and matching logic.</li><li>Liaise with providers and internal teams to resolve questions about EDI and Claims Intake rejections.</li><li>Provide second-level expert support for intake claim rejections.</li><li>Analyze large datasets for research and troubleshooting.</li><li>Collaborate with Product Owners and IT teams on system enhancements and fixes.</li><li>Participate in testing and verification of business rules and validations.</li><li>Manage multiple projects and tasks simultaneously while maintaining high-quality results.</li><li>Support Product Owners, Business Owners, and Leads using technical and analytical expertise.</li><li>Communicate effectively across all levels of the organization, including cross-functional teams.</li><li>Write complex SQL queries to join multiple data sources and analyze data for root causes, trends, and opportunities.</li><li>Analyze EDI and Claims intake rejections from internal and external inquiries, including provider calls.</li><li>Track and execute solutions for identified issues.</li><li>Perform User Acceptance Testing for logic changes and enhancements.</li><li>Develop utilities, queries, and processes for post-production checkout of business rules and system fixes.</li></ul><h1></h1>Required Qualifications<ul><li>5+ years of experience as a SQL Server power user (coding and developing data extracts).</li><li>5+ years of data interpretation and analysis experience.</li><li>5+ years querying large datasets using SQL, SAS, or other data tools.</li><li>Strong documentation skills; writing readable and reproducible code.</li><li>Process improvement mindset; strives to simplify complex processes.</li><li>Proficient in Word, PowerPoint, Excel.</li><li>Experience working independently and prioritizing multiple deliverables.</li><li>Experience managing conflicting priorities and concurrent projects.</li><li>Excellent verbal and written communication skills with experience communicating technical information to non-technical audiences.</li></ul><h1></h1>Preferred Qualifications<ul><li>Advanced Excel skills (pivots, formulas, V-lookup).</li><li>2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s).</li></ul><h1></h1>Education<ul><li>Bachelor’s degree or equivalent work experience</li></ul></div>Pay RangeThe typical pay range for this role is:$75,400.00 - $165,954.00 This 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. This position also includes an award target in the company’s equity award program. 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 peopleWe 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:<ul><li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>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.</li></ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank" rel="noopener noreferrer">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 03/06/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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