Stop Loss Aggregate Analyst

Job not on LinkedIn

🕒 September 1

🏈 Alabama, Alaska, +44 more states – Remote

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💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 24%

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Logo of CVS Health

CVS Health

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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 to ensure accurate, timely reimbursements • Monitor assigned employer groups and clients using reports, analysis, and reimbursement activity trends • Research and reconcile discrepancies between requested reimbursement amounts and amounts returned by stop loss carriers • Help capture maximum eligible reimbursements under applicable stop loss policies • Review claim documentation for completeness, accuracy, and alignment with policy provisions and filing requirements • Research and resolve cases requiring additional analysis, documentation, or explanation • Communicate with internal and external stakeholders to obtain information, resolve issues, and support timely filing resolution • Partner with underwriting, finance, eligibility, and client support teams • Maintain accurate records, logs, and supporting documentation for assigned filings and reimbursements • Escalate complex issues or delays and support process improvement efforts

🎯 Requirements

• Minimum of 2 years of experience in healthcare claims processing or a related health insurance environment • Minimum of 2 years of experience using Microsoft Office applications, particularly Excel • Strong analytical, problem-solving, and organizational skills • Strong verbal and written communication skills • Ability to work independently and collaboratively across a matrixed team in a fast-paced environment • Strong attention to detail and ability to manage multiple priorities and deadlines • Preferred: Stop loss or reinsurance experience • Preferred: Experience preparing or supporting stop loss claim filings • Preferred: Experience reviewing plan documents, policy provisions, or reimbursement-related documentation • Preferred: Exposure to IBM AIX or AS/400 mainframe environments

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Training available for the right candidate • Full-time comprehensive benefits package

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