Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance allegations tied to pharmacy contracts. The role requires coordinating with network pharmacies and internal teams to ensure compliance with contractual and regulatory requirements.

You will analyze claims data, prepare detailed responses for plan sponsors and stakeholders, and manage multiple cases while maintaining accuracy and working with cross-functional partners to improve

Qualifications

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

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

MS Office applications

Education

Bachelor's degree

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance allegations tied to pharmacy contracts. The role requires coordinating with network pharmacies and internal teams to ensure compliance with contractual and regulatory requirements.

You will analyze claims data, prepare detailed responses for plan sponsors and stakeholders, and manage multiple cases while maintaining accuracy and working with cross-functional partners to improve