Stop Loss Claims Operations Manager, Remote

CVS Health • Amherst, NY

3d • Remote

About The Position

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.

Requirements

• 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

Nice To Haves

• Prior experience managing large teams
• Medical Claims Operations exposure

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

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees