Job Title

Job DescriptionActs as a liaison and subject matter expert between our internal and external clients and the stop loss administrators. Reviews and manages stop loss claim filings. Resolves discrepancies between the amount requested and the amount reimbursed by the stop loss carrier.Required Qualifications Manages the escalation of complex cases from Analysts to Team Lead or Stop Loss Management () Responsible for the reimbursement of stop loss filings and monitoring of controls related to the reimbursements. May be responsible to review and direct the flow of provider refunds related to specific stop loss cases May be required to release and direct print provider payments from the ECHO environment Month end review process to identify specific stop loss claims/filings requiring urgent and timely submission () May perform other special functions as directed (e.g. In/Out Postings, Meritain Specific Accommodation, etc.) Back up duties to support the stop loss team (e.g. PTO, Absences, Managing Work Loads, etc.) Other duties as assigned and determined by Stop Loss managementCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsClaims processing experience1 yr+ Stop Loss processing experienceExperience in a production environmentDemonstrated ability to manage multiple assignments competently, accurately and efficientlyStrong oral and written communication skillsDetail oriented with the ability to work both independently and within a team structureEducationAssociate's degree or equivalent work experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.