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

At CVS Health, weu2019re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nationu2019s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues u2013 caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The Medicaid Intake Operations Team plays 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. We are seeking a dynamic, self-motivated Technical Analyst with a strong foundation in SQL , EDI transactions , and claims operations . In this role, you will: + 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. Primary Duties and Responsibilities + 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. Required Qualifications + 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. Preferred Qualifications + Advanced Excel skills (pivots, formulas, V-lookup). + 2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s). What Weu2019re Looking For + Flexibility and adaptability to meet team needs. + Comfort working in a fast-paced, evolving environment. + Commitment to continuous learning and professional growth. + A process improvement mindset. Education + Bacheloru2019s degree or equivalent in Information Systems, Computer Science, or a related field; or equivalent combination of education and experience. Pay Range The 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 companyu2019s 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 people We take pride in our comprehensive and competitive mix of pay and benefits u2013 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 We anticipate the application window for this opening will close on: 11/10/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-03