Pharmacy Compliance Analyst — Hybrid

Wellmark, Inc.; Iowa; Hybrid; USD 70,000 - 100,000; Full time

Job summary

Wellmark, Inc. is seeking a Pharmacy Compliance Analyst to join our Pharmacy Services team. This role partners with Legal, Regulatory Compliance, Pharmacy Quality Assurance, and broader Pharmacy to ensure regulatory compliance and respond to audits.

You will research, track, and report compliance inquiries and coordinate across the organization to remediate issues. Ideal candidates have strong project management and communication skills, with 4+ years in health insurance or related fields, and a

Qualifications

• Bachelor’s degree or direct and equivalent work experience.
• 4+ years of health insurance, health care, or related industry experience with rules and policies.
• Strong analytical skills to recognize inconsistencies and derive conclusions.
• Aptitude to learn on compliance best practices in pharmacy.

Responsibilities

• Manage day-to-day regulatory compliance related to pharmacy, coordinating with leadership and staff to report on status and resolution.
• Support oversight of Exchange tasks including CMS audits and audit findings recommendations.
• Serve as the NCQA expert: gather evidence for annual submission and audits.
• Serve as the HEDIS expert: review and update data for audits and accreditation.
• Gather and submit MCAS data for annual submission to Division of Insurance.
• Ensure pharmacy policies are updated annually; develop new policies as needed.
• Support corporate compliance and ethics functions and advise business units on laws and ethics.
• Attend pharmacy team meetings to provide updates on compliance issues and projects.
• Collaborate with Compliance staff on Medicare Advantage PDP business matters.
• Participate in and document audits as requested for internal and external audits.

Skills

Regulatory analysis

Project management

Communication

Microsoft Office

Education

Bachelor's degree

Tools

CMS audit software

Data analysis tools

Job description

Wellmark, Inc. is seeking a Pharmacy Compliance Analyst to join our Pharmacy Services team. This role partners with Legal, Regulatory Compliance, Pharmacy Quality Assurance, and broader Pharmacy to ensure regulatory compliance and respond to audits.

You will research, track, and report compliance inquiries and coordinate across the organization to remediate issues. Ideal candidates have strong project management and communication skills, with 4+ years in health insurance or related fields, and a