At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – 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 Business Operations team seeks an analyst with expertise in electronic claim transactions and claims operations. This team ensures the quality and integrity of Intake processes for all Medicaid incoming claim transactions. In this position, you will provide initial support for SNIP and Intake rejections to key stakeholders such as Health Plan Provider Representatives and Service Operations Call Center Representatives for intake-related inquiries. You will conduct research and triage claim inquiries, communicating findings and next steps to business stakeholders. Additionally, you will work with EDI Product Owners and Technology teams to identify system enhancements and bug fixes. You will also outline key intake rules by conducting research from CMS/State websites and analyzing Claims and Encounters root cause findings. **Primary duties and responsibilities** + Support Product Owners, Business Owners and Leads, using working knowledge of Clearinghouse, Claims and Encounters to support the service operations teams. + Interface and communication at varying levels of the organization, including direct communication with cross-functional areas across the company; coordination with Operations, SMEs and IT teams will be key to success. + Monitor key production and operational reports and metrics to detect any reconciliation failures, process failures, missing claims or files and work with Technology production support team to remediate. + Own and articulate requirements for claims intake rules, provider and member selection logic based on market, State and CMS guidelines. + Connect the process gaps using working knowledge of Clearinghouse and Claims Adjudication processes. + Perform analysis of SNIP and Claims intake rejections stemming from internal as well as stakeholder inquiries including provider calls while also tracking and executing solutions. + Perform research and triage for claim inquiries and coordinate with the intake support team to validate system functionality and log change requests. + Assist during CMS and other audits, RFPs and participate in conversations with fiscal intermediaries (e.g., Gainwell, etc.) for requirements around EDI and Provider edits, etc. + User Acceptance Test logic changes and enhancements. **Required Qualifications** + 2+ years working on EDI transactions including but not limited to 837s, 277s, 999s, 275s, 835s, etc. + 2+ years of experience in EDI and Claims operations. + Working knowledge of Clearinghouse operations. + Proficient in Word, PowerPoint, Excel. + Initiative-taker with the ability to work independently and effectively prioritize multiple deliverables. + Excellent verbal and written communication skills with ability to communicate technical ideas and results to non-technical clients in written and verbal form. **Preferred Qualifications** + Demonstrated ability with Excel (pivots, formulas, and V-look up) + Experience executing pre-formatted, simple SQL statements to help with operational monitoring. + Experience working with Tableau reports preferred. + We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. **What we’re looking for:** + Flexibility and the willingness to adapt to meet the needs of the team. + Someone who is an initiative-taker and comfortable in a fast-paced and ever-evolving environment. + A life learner who is constantly working to improve their professional knowledge. + A process improvement mindset, always looking to improve processes. **Education** Bachelor’s degree or equivalent in Information Systems, Computer Science, or Delivery Management or equivalent combination of education and experience. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $122,400.00 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. 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: 08/01/2025 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.