Stop Loss Claims Operations Manager, Remote

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary Join Meritain, a subsidiary of reputed company as the Manager of Stop Loss/Reinsurance Operations. In this high impact role, you will reputed company 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 reputed company 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 reputed company 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 reputed company to influence and collaborate across reputed company levels of the organization. Additional Responsibilities:

• Receives and investigates escalated and reputed company 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 reputed company requirements.
• Functions as back-up to staff and peers as necessary Required Qualifications
• Minimum 5 years operations (claims, eligibility, plan setup, implementation) or reputed company 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 40 Time Type Full time Pay Range The typical pay range for this role is: $54,300.00 - $159,120.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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 reputed company 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 We anticipate the application window for this opening will reputed company on: 12/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area.

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