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Job Details


CVS Health

Sr Claim Benefit Specialist - Stop Loss

Pharmaceuticals

All

Yearly

No

Amherst, New York, United States

Job Description
Acts 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.
Fundamental Components and Physical Requirements include but are not limited to (*denotes essential function)
• Acts as principal point of contact for stop loss administrators (*)
• Review and investigate inquiries from stop loss administrators (*)
• Manage and/or request retro pre-cert reviews, medical necessity inquiries, medical records & physician orders, etc.(*)
• Utilize all applicable system functions and department relationships to finalize stop loss filings (*)
• Review, adjudicate and appeal as necessary mismatched stop loss reimbursements (*)
• Use system reporting tools to maintain and manage daily work flow (*)
• Maintaining good relationships with internal and external clients

Pay Range
The typical pay range for this role is:
Minimum: 38500
Maximum: 70000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
- Claims processing
- Ability to work independently and maintain service standards
- Technical and Analytical skills
- Proficiency in oral and written communications
- Must be willing and able to work in an office environment a
minimum of two days a week

COVID Requirements


COVID-19 Vaccination Requirement
CVS 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 Qualifications
- Stop Loss experience preferred

Education
High School or GED equivalent

Business Overview
Bring your heart to CVS Health
Every 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.