Pharmacy Network Compliance Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations within the pharmacy network. The role requires handling sensitive cases, coordinating with cross-functional teams, and ensuring compliance with contractual and regulatory requirements.

The analyst will conduct outreach to network pharmacies, analyze claims data, and prepare detailed written responses for plan sponsors and stakeholders, while maintaining

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.
• Conduct outreach to pharmacies to gather information and address 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 accuracy.

Skills

Retail pharmacy experience

Claims adjudication research

MS Office proficiency

Oral and written communication

Analytical thinking

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 within the pharmacy network. The role requires handling sensitive cases, coordinating with cross-functional teams, and ensuring compliance with contractual and regulatory requirements.

The analyst will conduct outreach to network pharmacies, analyze claims data, and prepare detailed written responses for plan sponsors and stakeholders, while maintaining