Pharmacy Network Compliance Specialist

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

Benefits offered by this job

Great benefits for great people

Comprehensive benefits package

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations. The role requires coordinating with network pharmacies and cross-functional partners to ensure contractual and regulatory compliance.

The position demands 3+ years in retail pharmacy, 2+ years in claims adjudication research, and strong Microsoft Office skills. You will prepare detailed responses for plan sponsors and stakeholders while maintaining thorough

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

Analytical thinking

Attention to detail

Oral and written communication

Time management

Organizational skills

Decision-making

Education

Bachelor's degree

Tools

Microsoft Office

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance allegations. The role requires coordinating with network pharmacies and cross-functional partners to ensure contractual and regulatory compliance.

The position demands 3+ years in retail pharmacy, 2+ years in claims adjudication research, and strong Microsoft Office skills. You will prepare detailed responses for plan sponsors and stakeholders while maintaining thorough