Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations within our pharmacy network. You will manage multiple cases, analyze claims data and prepare responses for stakeholders.

The role requires 3+ years in retail pharmacy, 2+ years in claims adjudication research, and strong proficiency with Microsoft Office. Bachelor's degree is required.

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 issues identified.
• 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

Claims adjudication research

MS Office

Education

Bachelor's degree

Tools

Pharmacy operating systems

Claims adjudication software

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations within our pharmacy network. You will manage multiple cases, analyze claims data and prepare responses for stakeholders.

The role requires 3+ years in retail pharmacy, 2+ years in claims adjudication research, and strong proficiency with Microsoft Office. Bachelor's degree is required.