Pharmacy Network Compliance Analyst

Stryker Corporation; Boise (ID); On-site; Confidential; Full time

Benefits offered by this job

Great benefits

Comprehensive benefits package

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance cases. This role requires a detail-oriented professional who can manage multiple priorities and collaborate with cross-functional teams.

You will conduct outreach to pharmacies, analyze claims data, prepare written responses for sponsors and stakeholders, and maintain thorough documentation while meeting deadlines.

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

Excel

Outlook

Word

Pharmacy software

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance cases. This role requires a detail-oriented professional who can manage multiple priorities and collaborate with cross-functional teams.

You will conduct outreach to pharmacies, analyze claims data, prepare written responses for sponsors and stakeholders, and maintain thorough documentation while meeting deadlines.