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

The Non-MAC team is responsible for reviewing and responding to all pharmacy Non-MAC pharmacy appeals and collaborating with the Legal team to respond to any Non-MAC related complaints from state agencies.

Responsibilities:
Non-MAC Pricing Compliance & Inquiry Resolution
Review and resolve pharmacy inquiries related to Non-MAC  pricing, ensuring compliance with Non-MAC law requirements.

Data Validation & Source Verification
Validate pricing and product information using trusted sources such as Medispan and wholesaler information.

Market Monitoring & Issue Escalation
Identify changes in marketplace conditions and promptly escalate potential issues to
leadership to minimize impact on pharmacies and plan members.

Team Support & Training
Assist the Non-MAC team contractors by answering questions and providing training support as needed.

IT Implementation Testing
Back up lead tester by monitoring and performing testing activities related to IT system implementations to ensure functionality and accuracy as needed.

Regulatory Inquiry Support
Research and respond to Department of Insurance (DOI) inquiries, providing accurate and
timely information to the DOI team to submit to state regulators.

Ad Hoc Management Support
Provide assistance to management with various ad hoc tasks and special projects as
assigned.

Required Qualifications
Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes, state regulations, and claims adjudication, including claims adjudication logic
Experience with RxClaim platform (AS400)

Education
Bachelor's Degree required

Preferred Qualifications
• Proficient in Excel, Word, Salesforce, and Pharmacy Portal
• Ability to work under tight deadlines
• Strong mathematical problem-solving skills
• Familiarity with wholesaler invoices

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $40.90

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: 10/09/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.