Stop Loss Aggregate Analyst

Position Summary

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.

• 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.

• 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.

40

Full time

The typical pay range for this role is: $18.50 - $35.29. This 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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

This job does not have an Final date to receive applications, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.