Pharmacy Network Compliance Analyst

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

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance allegations within our pharmacy network. This role requires meticulous analysis, cross-functional collaboration, and strong communication to ensure contracts and regulatory requirements are met.

You will conduct outreach to pharmacies, evaluate issues, and prepare clear responses for sponsors and stakeholders while maintaining rigorous documentation and timelines.

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

Retail pharmacy

Claims adjudication research

Microsoft Office

Education

Bachelor's degree

Tools

Microsoft Office

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex non-compliance allegations within our pharmacy network. This role requires meticulous analysis, cross-functional collaboration, and strong communication to ensure contracts and regulatory requirements are met.

You will conduct outreach to pharmacies, evaluate issues, and prepare clear responses for sponsors and stakeholders while maintaining rigorous documentation and timelines.