Senior Business Analytics Analyst
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Maryland • United States
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Salary
💰 $46,988 - $112,200 per year
Job Level
About the role
- Manage daily Maryland Medicaid claims pend buckets to ensure timely and accurate claims adjudication and payment
- Oversee inventory levels, turnaround times (TAT), backlog reduction, reduction of claims interest, suspended claims work queues, and provider dispute resolution
- Drive improvements in auto-adjudication rates, accuracy, and first-pass resolution
- Ensure all claims processes comply with State Medicaid regulations and billing guidelines, CMS requirements and Federal managed care rules, and timely filing laws
- Support readiness reviews, audits, Corrective Action Plans (CAPs), and state submissions
- Implement QA programs to monitor claim accuracy, provider payment integrity, and policy adherence
- Review and analyze claims performance dashboards, error trends, and key metrics
- Partner with Finance on claims reserves and cost-of-care reporting
- Work closely with Configuration, Cotiviti, and Claim Xten to resolve system issues
- Collaborate with Utilization Management/Medical Management on authorization-related claims issues
- Coordinate with Compliance and Legal on regulatory changes and required process updates
- Lead initiatives to streamline workflows, automate processes, reduce manual interventions, and improve accuracy
- Drive root-cause analysis and implement sustainable corrective actions
- Participate in the development of policy and procedure updates for Medicaid claims operations
Requirements
- Bachelor’s degree in Business, Healthcare Administration, or related field
- 3+ years of claims experience in Medicaid
- Strong understanding of Medicaid billing rules, HSCRC, provider types, benefit structures, and encounter reporting
- Experience with major claims systems (e.g., QNXT)
- Problem solving mindset; adaptable, ability to analyze processes
- Analytical skills with proficiency in Excel and claims data analysis
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- comprehensive benefits package designed to support physical, emotional, and financial well-being
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims adjudicationauto-adjudicationclaims performance analysisclaims data analysisQA programsroot-cause analysisMedicaid billing rulesencounter reportingExcel proficiencybacklog reduction
Soft Skills
problem solvingadaptabilityanalytical skillscollaborationleadershipcommunicationorganizational skillsprocess improvementattention to detaildispute resolution
Certifications
Bachelor’s degree in BusinessBachelor’s degree in Healthcare Administration