CVS Health is looking for a Healthcare Compliance Senior Analyst to ensure our pharmacy systems comply with contractual and regulatory standards for third-party programs. You will serve as the key liaison between internal departments and external entities like health plans, PBMs, and government agencies, facilitating the maintenance and setup of systems so CVS pharmacies can service and bill prescriptions effectively.

What You'll Do

Review communications from PBMs, processors, health plans, and government agencies to make informed decisions about prescription and medical claim processing.
Act as a subject matter expert by researching insurance program requirements, billing policies, and compliance inquiries.
Proactively identify and resolve third-party operational issues.
Ensure compliance with payer contracts and NCPDP standards.
Communicate payer information clearly to internal teams and CVS pharmacy locations.
Draft third-party articles for the Payer Relations Weekly Update and issue emergency communications via the pharmacy HUB.
Maintain effective working relationships with contracted agencies, PBMs, and health plans.
Serve as a problem-solving contact for payer-related complaints and inquiries.
Collaborate with payers and internal teams to improve claim processing and customer service.
Keep Contracting Directors and management informed of significant payer-related issues.
Assess third-party information to determine system update needs.
Track plan changes and prepare documentation for new or updated third-party plan codes.
Work with internal teams to determine the best approach for system updates.
Address prescription processing escalations from internal departments and pharmacy teams.
Support team goals and adapt to changing business needs.
Assist with implementing procedures, policies, and projects to improve payer and customer support processes.

What We're Looking For

Minimum 3 years of experience in the pharmacy industry.
Familiarity with standard contract terms, business policies, and best practices.
High School Diploma or equivalent work experience.

Nice to Have

Knowledge of Pharmacy Benefit Management.
Strategic thinking with tactical execution.
Strong organizational and multitasking abilities.
Self-starter with leadership and interpersonal skills.
Ability to influence across a matrixed organization.
Bachelor’s Degree.

Benefits & Compensation

Salary range: $46,988.00 - $112,200.00
Affordable medical plan options.
401(k) plan with matching company contributions.
Employee stock purchase plan.
No-cost wellness screenings, tobacco cessation and weight management programs.
No-cost confidential counseling and financial coaching.
Paid time off.
Flexible work schedules.
Family leave.
Dependent care resources.
Colleague assistance programs.
Tuition assistance.
Retiree medical access.

Work Mode

This is a full-time position.

CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.