Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Medical, dental, vision

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance cases across the network. You will engage with pharmacies, evaluate issues, and collaborate with cross-functional partners to ensure contractual and regulatory compliance while delivering strong service levels.

The role requires 3+ years in retail pharmacy and 2+ years in claims adjudication research, with proficiency in Microsoft Office.

Qualifications

• Bachelor's degree required.
• 3+ years retail pharmacy experience.
• 2+ years claims adjudication research experience.
• 2+ years Microsoft Office (Excel/Outlook/Word) experience.

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 while meeting deadlines and maintaining accuracy.

Skills

3+ years retail pharmacy experience

2+ years claims adjudication research

2+ years Microsoft Office (Excel/Outl/

Education

Bachelor's degree

Tools

Pharmacy operating systems

Claims adjudication software

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance cases across the network. You will engage with pharmacies, evaluate issues, and collaborate with cross-functional partners to ensure contractual and regulatory compliance while delivering strong service levels.

The role requires 3+ years in retail pharmacy and 2+ years in claims adjudication research, with proficiency in Microsoft Office.