Senior Claim Benefit Specialist - Stop Loss (Hybrid)

Hispanic Alliance for Career Enhancement; Plymouth (MN); On-site; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated individual to join their dynamic healthcare team. This role offers a unique opportunity to engage in healthcare claims administration, providing essential support to stakeholders and managing critical claim processes. You will develop your skills in problem-solving and communication while receiving extensive training and a clear career path. With a commitment to employee wellness and a comprehensive benefits package, this position promises a rewarding and fulfilling career in a fast-paced environment. If you are passionate about healthcare and eager to grow, this opportunity is for you.

Benefits

Affordable Medical Plan Options

401(k) Plan with Matching Contributions

Employee Stock Purchase Plan

Wellness Screenings

Tobacco Cessation Programs

Weight Management Programs

Confidential Counseling

Financial Coaching

Paid Time Off

Tuition Assistance

Qualifications

• 1+ years of experience in healthcare claims processing.
• 2+ years of experience with Microsoft applications, especially Excel.

Responsibilities

• Manage stop loss claim filings and reconcile discrepancies.
• Act as a liaison between internal and external stakeholders.

Skills

Healthcare Claims Processing

Microsoft Excel

Communication Skills

Problem Solving

Interpersonal Skills

Education

High School Diploma or GED

Tools

IBM AIX

AS/400

Job description

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
Are you looking for an exciting opportunity to join a dynamic team that is an important, strategic part of a Fortune 5 company in one of the fastest growing fields in the healthcare industry? This challenging role provides exposure to virtually all aspects of healthcare claims administration, from reinsurance/stop loss, data analytics, provider and broker relations, underwriting, eligibility, finance, client management and much more. Develop and hone your skills as a critical thinker, problem solver, and highly effective communicator with a meticulous eye for detail and superior organization - foundational skills that will serve you throughout your entire career. We will provide extensive training and a promising career path for the right candidate willing to learn and grow into a promising and stable line of work.

You will act as an important liaison and subject matter expert between our internal and external stakeholders and the stop loss administrators. Managing stop loss claim filings, you will reconcile and resolve discrepancies between the amount requested and the amount reimbursed by the stop loss carrier.

Required Qualifications
*Minimum of 1 year of experience in healthcare claims processing
*Minimum of 2 years of experience with the suite of Microsoft applications (particularly Excel)

Preferred Qualifications

*Ability to work independently across a matrix team in a fast-paced environment
*Strong interpersonal and communication skills (verbal and written) and pride in your work
*Experience in stop loss administration

*Exposure to a mainframe IBM AIX or AS/400 environments (i.e. "green screen", command driven platforms)

Education

*High School matriculate or GED equivalent

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

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, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/31/2025

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