Strategic Stop-Loss Claims Analyst

CVS Health Corporation; Northern (KY); Hybrid; USD 26,000 - 48,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health Corporation is seeking a Stop Loss Claims Analyst to support filing activity for a portfolio of self-funded groups. You will prepare and marshal filings, track reimbursements, and partner with underwriting, finance, and client support to ensure accurate, timely resolutions.

The role emphasizes attention to detail, analytical thinking, and the ability to work across multiple stakeholders in a fast-paced environment. Training is available for the right candidate.

Qualifications

• 2+ years of experience in healthcare claims processing or health insurance environment.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication.
• Ability to work independently and in a matrixed team.
• Proficiency with Microsoft Office applications, especially Excel.

Responsibilities

• Prepare, update, and submit stop loss filing packages including initial, subsequent, and year-end filings.
• Track claim activity and ensure reimbursements are received accurately and timely with carriers.
• Monitor employer groups and clients using reports and reimbursement trends.
• Research and reconcile discrepancies between requested reimbursements and paid amounts.
• Advocate for clients to maximize eligible reimbursements under stop loss policies.
• Review claim docs for completeness, accuracy, and policy alignment with filing requirements.
• Collaborate with underwriting, finance, eligibility, and client support to resolve filings.
• Maintain logs and documentation for filings and reimbursements.
• Escalate complex issues and support process improvements when gaps are found.

Skills

Analytical skills

Communication skills

Organizational skills

Excel

Independent & collaborative work

Tools

Excel

IBM AIX/AS/400

Job description

CVS Health Corporation is seeking a Stop Loss Claims Analyst to support filing activity for a portfolio of self-funded groups. You will prepare and marshal filings, track reimbursements, and partner with underwriting, finance, and client support to ensure accurate, timely resolutions.

The role emphasizes attention to detail, analytical thinking, and the ability to work across multiple stakeholders in a fast-paced environment. Training is available for the right candidate.