Job Description
In this role, you will spend the majority of your time working independently in a highly structured, data-focused environment. Your day will revolve around managing large claim files, converting them into CMS-compliant PDE submissions, and ensuring accuracy through detailed Excel manipulation and validation. You’ll initiate and complete weekly PDE cycles, retrieve and process CMS response files, and prepare reports for internal teams. This is a heads-down position that requires precision, consistency, and comfort with repetitive tasks—perfect for someone who enjoys deep work with data and thrives on meeting strict deadlines without frequent client interaction.
• PDE Cycle Management
o Run and manage weekly PDE cycle submissions (previously 3-week cycles).
o Convert claims data into CMS-compliant PDE files using internal systems.
o Prepare files for submission to CMS vendor (CSSC).
• Data Processing & Reporting
o Manipulate Excel files for cycle initiation and acceptance.
o Retrieve CMS response files, process results, and update internal systems.
o Generate and format reports for internal teams and clients (accepted/rejected PDEs).
• Quality & Compliance
o Validate PDE files against CMS standards.
o Ensure accuracy and timeliness of submissions.
• Collaboration
o Work closely with PDE Analysts and Supervisors (no direct client or IT interaction).
o Support narrative reviews and statistical summaries for compliance reporting.
• Volume Management
o Handle high-volume claim data efficiently during accelerated weekly cycles.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
o High School Diploma or GED required.
o Minimum 1+ year experience in healthcare, Medicare, or claims processing.
o Intermediate Excel skills (formulas, VLOOKUP, pivot tables).
o Ability to work with large data files and perform accurate data manipulation.
o Understanding of Medicare Part D and claims adjudication processes.
o Familiarity with CMS requirements for PDE submissions.
o Highly detail-oriented and self-sufficient.
o Comfortable with repetitive, structured tasks.
o Ability to meet strict deadlines in a weekly cycle environment.
o Must work PST hours (remote allowed).
o Strong problem-solving for data/reporting issues (not system fixes).
o Comfortable with proprietary systems and internal tools.
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.