Pharmacy Network Integrity Analyst

Hispanic Alliance for Career Enhancement; Denver (CO); 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 pharmacy contract non-compliance allegations across our network. You will work with cross-functional teams, perform data analysis of claims, and communicate findings to plan sponsors and stakeholders, ensuring adherence to contractual and regulatory requirements while delivering excellent service.

The role emphasizes collaboration, detailed investigations, and timely resolutions in a dynamic

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

3+ years of retail pharmacy experience

2+ years of claims adjudication search

2+ years of Microsoft Office

Education

Bachelor's degree

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance allegations across our network. You will work with cross-functional teams, perform data analysis of claims, and communicate findings to plan sponsors and stakeholders, ensuring adherence to contractual and regulatory requirements while delivering excellent service.

The role emphasizes collaboration, detailed investigations, and timely resolutions in a dynamic