Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Annapolis (MD); On-site; USD 43,888 - 102,081; Full time

Job summary

CVS Health is looking for an Analyst – Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations within our pharmacy network. The role requires meticulous outreach to network pharmacies and collaboration with cross-functional partners to ensure adherence to contractual and regulatory requirements.

The successful candidate will analyze claims adjudication results, prepare detailed responses for stakeholders, and address customer concerns while managing

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

Analytical thinking

Attention to detail

Oral and written communication

Time management

Decision-making

Self-motivation

Education

Bachelor's degree

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Job description

CVS Health is looking for an Analyst – Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations within our pharmacy network. The role requires meticulous outreach to network pharmacies and collaboration with cross-functional partners to ensure adherence to contractual and regulatory requirements.

The successful candidate will analyze claims adjudication results, prepare detailed responses for stakeholders, and address customer concerns while managing