Pharmacy Network Compliance Analyst

CVS Health

Washington

On-site

USD 44,000 - 102,000

Full time

14 days+

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Benefits offered by this job

Benefits package

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Job summary

CVS Health is hiring an Analyst – Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance cases within the network. You will work with cross-functional teams to ensure adherence to contractual and regulatory requirements.

The role entails outreach to network pharmacies, analyzing claims data, and preparing detailed responses for sponsors and stakeholders while maintaining comprehensive documentation and meeting deadlines.

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