We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Stop Loss Claims Analyst supports stop loss claim filing activity for a portfolio of self-funded employer groups and clients. This role involves preparing, tracking, reconciling, and helping generate and marshal stop loss filings to completion while serving as a key liaison across internal business partners, external stakeholders, and stop loss carriers.
The position offers exposure to many areas of healthcare claims administration, including stop loss and reinsurance policy, data analytics, underwriting, eligibility, finance, client management, and provider and broker relations. It is well suited for someone who is detail-oriented, analytical, highly organized, and motivated to build expertise in a specialized area of the healthcare industry. Training is available for the right candidate who is ready to learn, grow, and develop in the role.
Key Responsibilities
- 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
- Monitor assigned employer groups and clients using reports, analysis, and reimbursement activity trends
- 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
Required Qualifications
- 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 Qualifications
- Stop loss or reinsurance experience
- Experience preparing or supporting stop loss claim filings
- Experience reviewing plan documents, policy provisions, or reimbursement-related documentation
- Exposure to IBM AIX or AS/400 mainframe environments
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $35.29This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health Boston, Massachusetts, USA Office
Boston, Massachusetts, United States, 02114
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