Network Management Analyst

Senior Analyst Pharmacy Network Non-Compliance

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.

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.

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: 40

Time Type: Full time

Pay Range: $43,888.00 - $85,068.00

This 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.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.