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

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 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.

• 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.

• 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.

• Advanced Excel skills (pivots, formulas, V-lookup).
• 2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s).

• 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.

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

• 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.