Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Providence (RI); On-site; USD 61,249 - 102,081; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance cases. You will engage with network pharmacies and cross-functional partners to ensure contractual and regulatory compliance.

The role requires strong analytical skills, attention to detail, and the ability to manage multiple investigations while delivering excellent service to plan sponsors, participants, and internal teams.

Qualifications

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

Responsibilities

• Investigate and resolve pharmacy contract non-compliance allegations.
• Conduct outreach to pharmacies to gather information and address issues.
• Analyze claims data and adjudication results to support findings.
• Partner with Sales, Account Management, and other internal teams to coordinate resolution.
• 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.

Skills

Retail pharmacy experience

Claims adjudication research

Microsoft Office proficiency

Analytical thinking

Education

Bachelor's degree

Tools

Claims adjudication software

Pharmacy operating systems

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance cases. You will engage with network pharmacies and cross-functional partners to ensure contractual and regulatory compliance.

The role requires strong analytical skills, attention to detail, and the ability to manage multiple investigations while delivering excellent service to plan sponsors, participants, and internal teams.