Stop Loss Claims Operations Manager, Remote

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Join Meritain, a subsidiary of CVS Health as the Manager of Stop Loss/Reinsurance Operations. In this high impact role, you will lead a team of about 12-15 colleagues who are responsible for the filing of Stop Loss claims to partner Managing General Underwriter (MGU) and Stop Loss Carriers, follow up, reconciliation and posting of Stop Loss reimbursements. As Manager, you will lead day to day colleague management, as well as issue resolution. You will be responsible for partnering across the Meritain organization, representing Meritain in conversation with Stop Loss carrier partners and for overall departmental performance.

We are seeking an operational innovator who thrives in a high-energy, fast-paced, and high-growth environment.  The ideal candidate will demonstrate the ability to seamlessly transition between strategic initiatives and tactical execution, while consistently delivering results. Strong verbal and written communication skills are essential, along with a proven capacity to influence and collaborate across all levels of the organization.

Additional Responsibilities:

•    Receives and investigates escalated and complex cases and works with Management and other departments to bring about resolution.
•    Provides direction for the Stop Loss staff in meeting their developmental goals.
•    Oversees the daily workflow and priorities to ensure business objectives are maintained.
•    Maintains monthly reporting statistics for Management
•    Participates in weekly prioritization process for system enhancements
•    Develops and maintains inter-departmental relationships necessary for teamwork and completion of objectives and goals.
•    Responsible for managing training requirements for new and existing staff
•    Build and maintain relationships with stop loss carriers to expedite urgent or special issues.
•    Fosters environment of compliance per Aetna requirements.
•    Functions as back-up to staff and peers as necessary
Required Qualifications

•   Minimum 5 years operations (claims, eligibility, plan setup, implementation) or related field; stop loss/reinsurance experience highly preferred

•   Progressive leadership experience managing projects and/or teams

•  Health Care or Insurance setting

Preferred Qualifications
•   Prior experience managing large teams

•   Medical Claims Operations exposure
Education
bachelor’s degree preferred/specialized training/relevant professional qualification.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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

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