Analyst, Network Management

CVS Health

Medicare Pharmacy Claims Auditor administering Medicare Part D compliance audit programs for CVS Health. Engaging with network pharmacies to verify claims and ensure compliance with regulations.

Posted 6/19/2026full-timeWork from Home • Arizona • 🇺🇸 United StatesJunior💰 $43,888 - $85,068 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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
High School Diploma or GED required

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

pharmacy claims processingdata entryaudit analysiscompliance reviewMicrosoft ExcelMicrosoft AccessSQL

Soft Skills

communicationcollaborationorganizational skillsproblem-solving

Certifications

Pharmacy Technician Certification Board (PTCB)High School DiplomaGED