Analyst, Network Management at CVS Health

, Arizona, United States -

Full Time

Start Date

Immediate

Expiry Date

18 Sep, 26

Salary

85068.0

Posted On

20 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Pharmacy Audit, Medicare Part D Compliance, Claims Processing, Data Analysis, Microsoft Excel, Microsoft Access, SQL, Communication, Time Management, Pharmacy Benefit Management, CMS Regulations, Internal Audit Systems

Industry

Hospitals and Health Care

Description

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. Position Summary This role offers an exciting opportunity to join CVS Caremark’s specialized Pharmacy Audit division as a Medicare Pharmacy Claims Auditor. In this position, you will administer assigned Medicare Part D compliance audit programs, conduct detailed reviews of pharmacy-submitted claims, and make independent, data-driven decisions. You will engage directly with network pharmacies to validate claim information, communicate audit requirements, and ensure adherence to CMS and CVS Health standards. Collaboration is essential, as you will partner with fellow auditors and cross-functional teams to successfully execute audit initiatives. The ideal candidate is highly motivated, detail-oriented, and possesses strong communication and time management skills. You will develop subject matter expertise in CVS Health Medicare Audit Programs and take ownership of designated program processes. This role also provides opportunities to innovate—designing tools, improving workflows, and contributing to solutions that enhance audit efficiency and effectiveness. Your work will directly support CVS Health’s compliance with CMS regulations and help maintain strong Medicare STAR ratings. Key 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 Preferred Qualifications 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. Education Requirements High School Diploma or GED required. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $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. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 06/23/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

Responsibilities

Administer Medicare Part D compliance audit programs by reviewing pharmacy-submitted claims and validating information with network pharmacies. Collaborate with cross-functional teams to ensure adherence to CMS and CVS Health standards while improving audit workflows.