Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Baton Rouge (LA); On-site; USD 43,888 - 102,081; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

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

The role requires 3+ years in retail pharmacy, 2+ years in adjudication research, and solid Excel/Word skills.

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

Education

Bachelor's degree

Tools

Microsoft Office (Excel, Outlook, Word)

Job description

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

The role requires 3+ years in retail pharmacy, 2+ years in adjudication research, and solid Excel/Word skills.