Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Great benefits for great people

Comprehensive benefits package

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations. The role requires attention to detail and the ability to manage multiple priorities.

You will conduct outreach to network pharmacies, analyze claims data, and collaborate with Sales, Account Management, and other teams to ensure compliance and clear responses to plan sponsors and stakeholders. Full-time role with benefits.

Qualifications

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

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 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.

Skills

Analytical thinking

Attention to detail

Communication skills

Education

Bachelor's degree

Tools

Microsoft Office (Excel, Outlook, Word)

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations. The role requires attention to detail and the ability to manage multiple priorities.

You will conduct outreach to network pharmacies, analyze claims data, and collaborate with Sales, Account Management, and other teams to ensure compliance and clear responses to plan sponsors and stakeholders. Full-time role with benefits.