Pharmacy Network Compliance Analyst

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

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance allegations within the pharmacy network. You will conduct outreach to network pharmacies, evaluate concerns, and collaborate with cross-functional partners to ensure compliance with contractual and regulatory requirements.

The role requires 3+ years in retail pharmacy, 2+ years in claims adjudication research, and strong Microsoft Office skills, with a Bachelor’s degree.

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

Retail pharmacy experience

Claims adjudication research

Microsoft Office (Excel/Outlook/Word)

Education

Bachelor's degree

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance allegations within the pharmacy network. You will conduct outreach to network pharmacies, evaluate concerns, and collaborate with cross-functional partners to ensure compliance with contractual and regulatory requirements.

The role requires 3+ years in retail pharmacy, 2+ years in claims adjudication research, and strong Microsoft Office skills, with a Bachelor’s degree.