Stop-Loss Claims Specialist

CVS Health Corporation; United States; Remote; USD 25,000 - 48,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings

Job summary

CVS Health Corporation is seeking a Stop Loss Claims Analyst to support filing activity for self-funded employer groups. The role involves preparing, tracking, reconciling, and coordinating stop loss filings while liaising with internal teams and external carriers.

The position exposes you to claims administration, underwriting, eligibility, and client management. Training is available for motivated candidates ready to learn and grow in a specialized healthcare area.

Qualifications

• Minimum of 2 years of experience in healthcare claims processing or related health insurance environment.
• Proficient in Microsoft Excel and Office applications.
• Strong analytical, problem-solving, and organizational skills.
• Strong verbal and written communication skills.
• Ability to work independently and with a matrixed team in a fast-paced environment.
• Keen attention to detail and ability to manage multiple priorities and deadlines.

Responsibilities

• Prepare, update, and submit stop loss filing packages, including initial, subsequent, and year-end filings.
• Track claim activity and follow up with stop loss carriers and stakeholders for timely reimbursements.
• Monitor employer groups and clients using reports and reimbursement trends.
• Research and reconcile discrepancies between requested reimbursements and amounts from carriers.
• Advocate for clients to capture maximum eligible reimbursements under policies.
• Review claim documentation for completeness and policy alignment.

Skills

Healthcare claims

Excel

Analytical thinking

Communication

Independent work

Attention to detail

Tools

IBM AIX

AS/400

Job description

CVS Health Corporation is seeking a Stop Loss Claims Analyst to support filing activity for self-funded employer groups. The role involves preparing, tracking, reconciling, and coordinating stop loss filings while liaising with internal teams and external carriers.

The position exposes you to claims administration, underwriting, eligibility, and client management. Training is available for motivated candidates ready to learn and grow in a specialized healthcare area.