Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Washington (District of Columbia); On-site; USD 43,888 - 102,081; Full time

Benefits offered by this job

Great benefits

Job summary

CVS Health is seeking an Analyst to investigate and resolve complex pharmacy contract non-compliance cases within a network of providers. The role collaborates with Sales, Account Management, and other internal teams to ensure compliant outcomes.

The position requires 3+ years of retail pharmacy experience, 2+ years of claims adjudication research, and strong MS Office skills. You will engage with pharmacies, document investigations, and prepare responses for stakeholders.

Qualifications

• 3+ years of retail pharmacy experience.
• 2+ years of claims adjudication research.
• 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 experience

Claims adjudication research

MS Office proficiency

Bachelor's degree

Education

Bachelor's degree

Tools

PBM systems

Pharmacy operating systems

Claims adjudication software

Job description

CVS Health is seeking an Analyst to investigate and resolve complex pharmacy contract non-compliance cases within a network of providers. The role collaborates with Sales, Account Management, and other internal teams to ensure compliant outcomes.

The position requires 3+ years of retail pharmacy experience, 2+ years of claims adjudication research, and strong MS Office skills. You will engage with pharmacies, document investigations, and prepare responses for stakeholders.