Stop Loss Aggregate Analyst

Job not on LinkedIn

🔥 35 minutes ago

🥔 Idaho, Minnesota, +1 more states – Remote

🥔 Idaho – Remote ❄️ Minnesota – Remote 🤠 Texas – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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 as needed • Track claim activity and follow up through to completion with stop loss carriers and other stakeholders to help ensure reimbursements are received accurately and timely • Monitor assigned employer groups and clients using reports, analysis, and reimbursement activity trends • Assist in researching and reconciling discrepancies between requested reimbursement amounts and amounts returned by stop loss carriers • Serve as an advocate for clients by helping capture the maximum eligible reimbursements available under applicable stop loss policies • Review claim documentation for completeness, accuracy, and alignment with policy provisions and filing requirements • Research and resolve cases that require additional analysis, documentation, or explanation • Communicate with internal and external stakeholders to obtain information, resolve issues, and support timely filing resolution • Partner with cross-functional teams, including areas such as underwriting, finance, eligibility, and client support, to facilitate filing resolution • Maintain accurate records, logs, and supporting documentation related to assigned stop loss filings and reimbursements • Escalate complex issues or delays appropriately and support process improvement efforts when trends or gaps are identified

🎯 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

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility