Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex network non-compliance issues within the pharmacy contracts. The role requires meticulous attention to detail and the ability to manage multiple priorities across cross-functional teams.

You will conduct outreach to network pharmacies, evaluate non-compliance concerns, and ensure adherence to contractual and regulatory requirements while delivering excellent service.

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 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

Claims adjudication research

Microsoft Office

PBM experience

Pharmacy systems knowledge

Attention to detail

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 network non-compliance issues within the pharmacy contracts. The role requires meticulous attention to detail and the ability to manage multiple priorities across cross-functional teams.

You will conduct outreach to network pharmacies, evaluate non-compliance concerns, and ensure adherence to contractual and regulatory requirements while delivering excellent service.