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
The typical pay range for this role is:
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.
- 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-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.
- Stop Loss experience preferred
High School or GED equivalent
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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.