Pharmacy Network Compliance Specialist

Hispanic Alliance for Career Enhancement; Austin (TX); 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 seeks an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations. This role requires a motivated, detail-oriented professional who can manage multiple priorities.

You will conduct outreach to network pharmacies, evaluate concerns, analyze claims adjudication results, and collaborate with Sales, Account Management, and internal teams to coordinate timely resolutions.

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 experience

Claims adjudication research

Microsoft Office (Excel, Outlook, Word

Bachelor's degree required

Education

Bachelor's degree

Tools

Microsoft Office

Job description

CVS Health seeks an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations. This role requires a motivated, detail-oriented professional who can manage multiple priorities.

You will conduct outreach to network pharmacies, evaluate concerns, analyze claims adjudication results, and collaborate with Sales, Account Management, and internal teams to coordinate timely resolutions.