Stop Loss Aggregate Analyst

Summary

CVS Health is building a more connected, convenient, and compassionate health experience around every individual. The Stop Loss Aggregate Analyst supports stop loss claim filing activity for self-funded employer groups and clients by preparing, tracking, reconciling, and completing filings while coordinating with internal partners, external stakeholders, and stop loss carriers.

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

Skills

• 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
• 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

Qualifications

Must Haves

• 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

Nice to Haves

• 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

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility