Analyst, Network Management

CVS Health is dedicated to building a world of health around every individual. They are seeking a Medicare Pharmacy Claims Auditor to join their specialized Pharmacy Audit division, where the role involves administering Medicare Part D compliance audit programs and conducting detailed reviews of pharmacy-submitted claims.

Responsibilities

• Conduct outbound calls to network pharmacies to verify claim information
• Distribute audit requests and documentation requirements to pharmacies
• Review prescriptions and supporting documents to ensure compliance with CMS and CVS Health contractual requirements
• Analyze incoming pharmacy documentation and accurately enter data into internal audit systems
• Respond to pharmacy inquiries related to Medicare audit programs
• Track and report progress on assigned audit activities
• Collaborate with internal stakeholders to align on audit objectives and business priorities

Skills

• High School Diploma or GED required
• 1+ years of experience in a pharmacy or Pharmacy Benefit Management (PBM) environment (5+ years preferred)
• 2+ years of experience with pharmacy claims processing systems
• Working knowledge of CMS Medicare Part D compliance regulations
• Advanced technical skills, including Microsoft Excel, Access, and SQL
• Pharmacy Technician Certification Board (PTCB) certification preferred

Benefits

• This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
• 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.

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