Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Great benefits

Bonus eligibility

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance cases. You will work with network pharmacies, evaluate concerns, and collaborate with Sales, Account Management and internal teams to ensure contractual and regulatory compliance.

Ideal candidates have 3+ years in retail pharmacy, 2+ years in claims adjudication research, proficiency with Microsoft Office, and a Bachelor's degree.

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, 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

Analytical thinking

Attention to detail

Oral and written communication

Time management

Stakeholder management

Retail pharmacy experience

Claims adjudication

Education

Bachelor's degree

Tools

Microsoft Office

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance cases. You will work with network pharmacies, evaluate concerns, and collaborate with Sales, Account Management and internal teams to ensure contractual and regulatory compliance.

Ideal candidates have 3+ years in retail pharmacy, 2+ years in claims adjudication research, proficiency with Microsoft Office, and a Bachelor's degree.