Network Management - Senior Analyst

CVS Health

About The Position

This position supports a Network Pricing team responsible for quality assurance and execution oversight of pharmacy network and pricing implementations for a single, dedicated PBM client across all lines of business. The Sr. Analyst ensures accuracy and compliance of pricing implementations across retail and mail pharmacy networks. The role is focused on validating the correct application of business rules, implementation processes, network structures, and pricing documents across supported delivery systems and adjudication platforms. In addition to QA/QC review activities, the Sr. Analyst provides operational support through review of implementation artifacts (e.g., Network Implementation Forms), downstream system validations (e.g., AS400 network profile coding validations), issue resolution, and ad‑hoc production support as needed. Success in this role requires strong attention to detail, the ability to manage multiple deadlines in a volume-driven environment, and comfort working both independently and collaboratively. Advanced Excel skills and the ability to interpret pricing and network data are essential.

Requirements

3–5 years of operational experience within a PBM or healthcare industry.
Experience working in a deadline‑driven, high‑volume production or QA environment.
Intermediate to advanced proficiency in Microsoft Office tools, with strong Excel skills required.
Strong analytical, organizational, and problem‑solving skills.
Ability to work effectively both independently and within a team environment.
Demonstrated written and verbal communication skills.
High School diploma or equivalent experience (required)

Nice To Haves

Quality assurance or audit experience within network pricing, pharmacy operations, or related functions.
Knowledge of PBM network pricing concepts, pharmacy operations, and claims adjudication.
RxClaim system experience.
Fundamental project management experience or exposure.
Bachelor’s degree or equivalent experience (preferred)

Responsibilities

Perform quality assurance reviews of pharmacy network and pricing implementations to ensure alignment with approved pricing documents, business rules, and network structures
Audit upstream implementation artifacts (e.g., network pricing forms, configuration inputs) and downstream system outputs to validate accurate execution
Support post‑implementation validation activities, including system profile reviews and issue research
Identify defects, variances, or risks; document findings and partner with implementation and pricing teams to drive resolution
Execute recurring and ad‑hoc operational tasks to support production timelines and QA workflows (e.g., Excel-based analysis, macros, reporting)
Maintain documentation and controls in support of audit, compliance, and regulatory requirements
Manage multiple deliverables concurrently while meeting strict deadlines
Communicate findings clearly to peers, leaders, and cross‑functional partners