Healthcare Compliance Senior Analyst

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

As a Healthcare Compliance Senior Analyst, you will ensure contractual and regulatory compliance related to third-party programs. You will serve as a liaison between internal departments and external entities such as health plans, processors, pharmacy benefit managers (PBMs), and governmental agencies. Your role includes facilitating the initiation and ongoing maintenance of pharmacy systems to ensure CVS pharmacies can service and bill prescriptions for patients enrolled in third-party programs.

Key Responsibilities

Third Party Information Management

• Review communications from PBMs, processors, health plans, and government agencies to make informed decisions regarding 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.

Relationship Building

• 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.

Plan Code Facilitation

• 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.

Teamwork

• 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.

Ideal Candidate Profile

• Strong verbal and written communication skills.
• High attention to detail and flawless execution.
• Independent thinker with problem-solving abilities.
• Professional demeanor and ability to multitask.
• Excellent organizational and prioritization skills.
• Proven collaboration skills with internal and external stakeholders.

Required Qualifications

• Minimum 3 years of experience in the pharmacy industry.
• Familiarity with standard contract terms, business policies, and best practices.

Preferred Qualifications

• 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.

Education

• High School Diploma or equivalent work experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, e