Stop-Loss Claims Analyst – Data & Reinsurance Focus

CVS Health; Saint Paul (MN); On-site; USD 38,000 - 73,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Stop Loss Claims Analyst to support stop loss filing activity for a portfolio of self-funded employer groups and clients. You will prepare, track, reconcile, and marshal filings while coordinating with stop loss carriers and internal teams to ensure accurate and timely reimbursements.

This role exposes you to healthcare claims administration, including data analytics, underwriting, eligibility, and client relations.

Qualifications

• 2+ years of experience in healthcare claims processing.
• 2+ years of experience using Microsoft Excel.
• Strong analytical, problem-solving, and organizational skills.
• Strong verbal and written communication skills.

Responsibilities

• Prepare and submit stop loss filing packages.
• Track claim activity to ensure timely reimbursements.
• Monitor employer groups using reports and reimbursement trends.
• Research discrepancies between requested and paid amounts.
• Advocate for clients to maximize reimbursements under stop loss policies.
• Review documentation for accuracy and policy alignment.
• Collaborate with underwriting, finance, eligibility, and client support.
• Maintain records and escalate complex issues as needed.

Skills

Healthcare claims

Excel

Analytical skills

Communication skills

Independent work

Attention to detail

Tools

IBM AIX

AS/400

Job description

CVS Health is seeking a Stop Loss Claims Analyst to support stop loss filing activity for a portfolio of self-funded employer groups and clients. You will prepare, track, reconcile, and marshal filings while coordinating with stop loss carriers and internal teams to ensure accurate and timely reimbursements.

This role exposes you to healthcare claims administration, including data analytics, underwriting, eligibility, and client relations.