Description

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

Are you looking for an exciting opportunity to join a dynamic team that is a key, strategic part of a Fortune 5 company in one of the fastest growing industry fields? This challenging role provides exposure to virtually all aspects of healthcare claims administration, from reinsurance/stop loss policy, data analytics, provider and broker relations, underwriting, eligibility, finance, client management and much more. Hone your skills as a proven critical thinker and problem solver with a meticulous eye for detail and superior organization - foundational skills that will serve you over your entire career. We will provide extensive training for the right candidate willing to learn and grow into a promising and extremely stable line of work.

You will act as an important liaison and subject matter expert throughout our internal and external stakeholder groups and the stop loss carriers that our clients contract with. Helping to managing stop loss claim filings, you will reconcile and resolve discrepancies between the amount requested and the amount reimbursed by the stop loss carrier. That responsibility will involve such things as:

• Serving as an advocate for our clients in helping to recover the maximum eligible reimbursements covered under the stop loss policies
• Utilizing rolling reports and analysis to monitor employer groups/clients assigned to you
• Both creating and updating system-generated and manually created stop loss filing package(s)
• Tracking and posting stop loss reimbursements
• Researching and resolving complex cases that require additional explanation
• Engaging with multiple functional areas as required in order to facilitate the overall resolution of impacted filings for employer groups in your assigned portfolio

Required Qualifications

• Minimum of 1 year of experience in healthcare claims processing
• Minimum of 3 year of experiences with the suite of Microsoft applications (particularly, Excel)
• Ability to work independently across a matrix team in a fast-paced environment
• Strong interpersonal and communication skills (verbal and written)

Preferred Qualifications

• Stop Loss/reinsurance experience
• Exposure to a mainframe IBM AIX or AS/400 environments

Education
Undergraduate Degree or 5 years equivalent work experience

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$17.00 - $38.82

This 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 03/13/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.