Reinsurance & Stop-Loss Claims Specialist

CVS Health; Lincoln (NE); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, and vision

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Reinsurance/Stoploss Claims Adjuster to review, research and adjust complex medical claims, coordinating with cross-functional teams to ensure accurate adjustments and timely responses to customer inquiries.

The role focuses on applying medical necessity guidelines, confirming coverage, eligibility, and cost containment measures while handling high-dollar claims and complex plan language. Full-time position with strong benefits.

Qualifications

• 2+ years medical claim processing experience.
• 2+ years in a production environment.

Responsibilities

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries and concerns.
• Perform adjustments across all dollar levels using claims processing expertise.
• Research plan year, identify payments, and interpret plan language for accurate handling.

Skills

Medical claim processing

Production environment

Claims adjustments/rework

Reinsurance/Stop loss familiarity

Communication & organization

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a Reinsurance/Stoploss Claims Adjuster to review, research and adjust complex medical claims, coordinating with cross-functional teams to ensure accurate adjustments and timely responses to customer inquiries.

The role focuses on applying medical necessity guidelines, confirming coverage, eligibility, and cost containment measures while handling high-dollar claims and complex plan language. Full-time position with strong benefits.