Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Des Moines (IA); On-site; USD 43,888 - 102,081; Full time

Benefits offered by this job

Great benefits for great people

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations. The role requires attention to detail, multi-tasking, and the ability to manage multiple cases while maintaining regulatory and contractual accuracy.

You will conduct outreach to network pharmacies, analyze claims data, coordinate with Sales, Account Management and others, and prepare thorough written responses for plan sponsors, participants, 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 is required.
• 2+ years of Pharmacy Benefit Management (PBM) experience.
• Experience contacting pharmacies and managing challenging or escalated conversations.
• Strong knowledge of pharmacy operating systems and claims adjudication software.
• Excellent oral and written communication skills with strong attention to detail.
• Demonstrated critical thinking and analytical skills.
• Strong organizational and time management skills.
• Self-motivated, assertive, and able to make independent decisions.

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

Education

Bachelor's degree

Tools

Microsoft 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. The role requires attention to detail, multi-tasking, and the ability to manage multiple cases while maintaining regulatory and contractual accuracy.

You will conduct outreach to network pharmacies, analyze claims data, coordinate with Sales, Account Management and others, and prepare thorough written responses for plan sponsors, participants, and