Network Management Analyst

CVS Health; Raleigh (NC); On-site; USD 43,888 - 102,081; Full time

Benefits offered by this job

Great benefits

Bonus eligibility

Job summary

CVS Health in Raleigh, NC is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations. The role requires a motivated, detail-oriented professional capable of managing multiple priorities.

Responsibilities include outreach to network pharmacies, evaluating non-compliance concerns, analyzing claims data, coordinating with Sales and Account Management, and preparing detailed written responses for plan sponsors and

Qualifications

• 3+ years of retail pharmacy experience.
• 2+ years of claims adjudication research experience.
• 2+ years of experience with Microsoft Office applications (Excel, Outlook, Word).
• Bachelor's degree required.

Responsibilities

• Investigate and resolve pharmacy contract non-compliance allegations, including complex and sensitive cases.
• Conduct outreach to pharmacies to gather information and address identified issues.
• Analyze claims data and adjudication results to support findings and recommendations.
• Partner with Sales, Account Management, and other internal teams to coordinate resolution efforts.
• Prepare detailed written responses for plan sponsors, participants, and internal stakeholders.
• Address and resolve customer concerns related to network pharmacy performance.
• Maintain thorough documentation of investigations and outcomes.
• Manage multiple cases simultaneously while meeting deadlines and maintaining accuracy.

Skills

Pharmacy experience

Claims research

Communication skills

Education

Bachelor's degree

Tools

Microsoft Office

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

The Analyst - Pharmacy Network Non-Compliance is responsible for investigating and resolving complex and sensitive pharmacy contract non-compliance allegations. This role requires a highly motivated, detail-oriented individual with the ability to manage multiple priorities effectively.

The Analyst will conduct outreach to network pharmacies, evaluate non-compliance concerns, and collaborate with cross-functional partners and ensure compliance with contractual and regulatory requirements, while maintaining strong relationships and delivering excellent service.

Key Responsibilities

• Investigate and resolve pharmacy contract non-compliance allegations, including complex and sensitive cases
• Conduct outreach to pharmacies to gather information and address identified issues
• Analyze claims data and adjudication results to support findings and recommendations
• Partner with Sales, Account Management, and other internal teams to coordinate resolution efforts
• Prepare detailed written responses for plan sponsors, participants, and internal stakeholders
• Address and resolve customer concerns related to network pharmacy performance
• Maintain thorough documentation of investigations and outcomes
• Manage multiple cases simultaneously while meeting deadlines and maintaining accuracy

Required Qualifications

• 3+ years of retail pharmacy experience
• 2+ years of claims adjudication research experience
• 2+ years of experience with Microsoft Office applications (Excel, Outlook, Word)
• Bachelor's degree required.

Preferred Qualifications

• 2+ years of Pharmacy Benefit Management (PBM) experience
• Experience contacting pharmacies and managing challenging or escalated conversations
• Strong knowledge of pharmacy operating systems and claims adjudication software
• Excellent oral and written communication skills with strong attention to detail
• Demonstrated critical thinking and analytical skills
• Strong organizational and time management skills
• Self-motivated, assertive, and able to make independent decisions

Core Competencies

• Analytical thinking and problem-solving
• Attention to detail and accuracy
• Excellent oral and written communication skills.
• Communication and stakeholder management
• Time management and prioritization
• Professional judgment and decision-making

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $102,081.00

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.

Benefits

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Acknowledgement

We anticipate the application window for this opening will close on: 08/21/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.