Pharmacy Network Compliance Analyst

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

Job summary

CVS Health is seeking a detailed Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations. The role requires managing multiple cases, performing data analysis, and coordinating with Sales, Account Management, and other teams to ensure contractual and regulatory compliance.

The successful candidate will conduct outreach to network pharmacies, prepare detailed written responses, and address customer concerns related to network

Qualifications

• 3+ years of retail pharmacy experience.
• 2+ years of claims adjudication research experience.
• Bachelor's degree required.

Responsibilities

• Investigate and resolve pharmacy contract non-compliance allegations.
• 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

MS Office proficiency

Education

Bachelor's degree required

Tools

Excel

Outlook

Word

Job description

CVS Health is seeking a detailed Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations. The role requires managing multiple cases, performing data analysis, and coordinating with Sales, Account Management, and other teams to ensure contractual and regulatory compliance.

The successful candidate will conduct outreach to network pharmacies, prepare detailed written responses, and address customer concerns related to network