Stop Loss Aggregate Analyst

Job not on LinkedIn

🔥 0 minutes ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

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 other stakeholders to ensure reimbursements are received accurately and timely • 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 related to 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 • 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 preferred

🏖️ 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 • Ongoing application acceptance with no application deadline