We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Analyst – Pharmacy Network Non-Compliance is responsible for investigating and resolving complex and sensitive pharmacy contract non-compliance allegations. This role requires a highly motivated, detail-oriented individual with the ability to manage multiple priorities effectively.
The Analyst will conduct outreach to network pharmacies, evaluate non-compliance concerns, and collaborate with cross-functional partners and ensure compliance with contractual and regulatory requirements, while maintaining strong relationships and delivering excellent service.
Key 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
Required 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.
Preferred Qualifications
- 2+ years of Pharmacy Benefit Management (PBM) experience
- Experience contacting pharmacies and managing challenging or escalated conversations
- Strong knowledge of pharmacy operating systems and claims adjudication software
- Excellent oral and written communication skills with strong attention to detail
- Demonstrated critical thinking and analytical skills
- Strong organizational and time management skills
- Self-motivated, assertive, and able to make independent decisions
Core Competencies
- Analytical thinking and problem-solving
- Attention to detail and accuracy
- Excellent oral and written communication skills.
- Communication and stakeholder management
- Time management and prioritization
- Professional judgment and decision-making
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$43,888.00 - $102,081.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 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
- 2+ years of Pharmacy Benefit Management (PBM) experience
- Experience contacting pharmacies and managing challenging or escalated conversations
- Strong knowledge of pharmacy operating systems and claims adjudication software
- Excellent oral and written communication skills
- Demonstrated critical thinking and analytical skills
- Strong organizational and time management skills
- Self-motivated, assertive, and able to make independent decisions
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
