Network Management Analyst

CVS Health•Work At Home-Arizona, AZ

10d•$43,888 - $85,068

About The Position

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 Senior 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 Senior 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.

Requirements

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.

Nice To Haves

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

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