Stop Loss Claims Analyst

CVS Health

Stop Loss Claims Analyst at CVS Health managing stop loss claim filing activities for self-funded employer groups. Responsible for tracking claims and ensuring reimbursements are received accurately and timely.

Posted 4/28/2026full-timeRemote • Idaho, Minnesota, Texas • 🇺🇸 United StatesJuniorMid-Level💰 $19 - $35 per hourWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

healthcare claims processingstop loss filingreimbursement analysisdiscrepancy reconciliationclaim documentation reviewdata analysisproblem-solvingorganizational skillsattention to detailmulti-priority management

Soft Skills

verbal communicationwritten communicationindependent workcollaborative workadvocacystakeholder engagementprocess improvementissue resolutionanalytical thinkingtime management