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.

　　Candidates should be located in or near either Lansing, MI, Amherst, NY or Plymouth, MN

　　Position Summary 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. Additional Responsibilities

　　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 (*)

　　Perform manual processes related to mid-year takeovers, plan year end, special handling clients, stop loss policy reviews, etc.(*)

　　Review Actively at Work (AAW) eligibility documents prior to submission to stop loss administrator (*)

　　Review and resolve mismatched filings prior to submission to stop loss administrator (retention review, aggregating-specific review, etc.) (*)

　　Review, adjudicate and appeal as necessary mismatched stop loss reimbursements (*)

　　Maintaining good relationships with internal and external clients

　　Escalate complex issues to Stop Loss Management as directed(*)

　　Use system reporting tools to maintain and manage daily work flow (*)

　　May perform processes (In/Out Posting) to finalize stop loss reimbursements systematically

　　Manage special accommodation product as required

　　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 management

　　Required Qualifications

　　Claims processing experience

　　1 yr+ Stop Loss processing experience

　　Experience in a production environment

　　Demonstrated ability to manage multiple assignments competently, accurately and efficiently

　　Strong oral and written communication skills

　　Detail oriented with the ability to work both independently and within a team structure

　　Preferred Qualification

　　Medical claims processing experience

　　Coaching and communication skills

　　Education

　　Associate’s degree or equivalent work experience

　　Pay Range

　　The typical pay range for this role is:

　　$18.50 - $35.29

　　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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

　　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.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.