Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Bonus/incentive program

Comprehensive benefits

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations, coordinating with network pharmacies and cross-functional teams. The role focuses on evaluating non-compliance concerns, analyzing claims data, and preparing detailed responses for plan sponsors and stakeholders while maintaining thorough documentation.

Ideal candidates have 3+ years in retail pharmacy, 2+ years in claims adjudication research, and

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.
• Conduct outreach to pharmacies to gather information and address issues.
• Analyze claims data and adjudication results to support findings.
• 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

Oral communication

Written communication

Time management

Attention to detail

Education

Bachelor's degree

Tools

Microsoft Office (Excel, Outlook, Word)

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations, coordinating with network pharmacies and cross-functional teams. The role focuses on evaluating non-compliance concerns, analyzing claims data, and preparing detailed responses for plan sponsors and stakeholders while maintaining thorough documentation.

Ideal candidates have 3+ years in retail pharmacy, 2+ years in claims adjudication research, and