Pharmacy Analytics & Compliance Specialist

CVS Health; Arizona; Hybrid; USD 29,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health in Arizona seeks a detail-oriented Non-MAC Reviewer to help manage pharmacy pricing appeals and regulatory inquiries. You will review Non-MAC pricing data, validate information from trusted sources, and partner with the Legal team to address state agency concerns.

The role requires PBM experience, familiarity with Non-MAC processes, and proficiency with data tools such as Excel and RxClaim (AS400).

Qualifications

• 4 years PBM experience with all non-MAC appeal related processes, state regulations, and claims adjudication, including claims adjudication logic
• Experience with RxClaim platform (AS400)

Responsibilities

• Review and resolve pharmacy inquiries related to Non-MAC pricing
• Validate pricing and product information using trusted sources
• Monitor marketplace conditions and escalate issues promptly
• Assist contractors with questions and training support
• Back up lead tester for IT system testing and accuracy
• Research and respond to Department of Insurance (DOI) inquiries
• Support management with ad hoc tasks and projects

Skills

PBM experience

Non-MAC appeals knowledge

Education

Bachelor's Degree or equivalent

Tools

RxClaim (AS400)

Job description

CVS Health in Arizona seeks a detail-oriented Non-MAC Reviewer to help manage pharmacy pricing appeals and regulatory inquiries. You will review Non-MAC pricing data, validate information from trusted sources, and partner with the Legal team to address state agency concerns.

The role requires PBM experience, familiarity with Non-MAC processes, and proficiency with data tools such as Excel and RxClaim (AS400).