Senior Claim Benefit Specialist - Stop Loss (Hybrid)

Posted:
3/5/2026, 2:58:32 AM

Location(s):
Woonsocket, Rhode Island, United States ⋅ Rhode Island, United States

Experience Level(s):
Senior

Field(s):
Customer Success & Support

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary
Are you looking for an exciting opportunity to join a dynamic team that is an important, strategic part of a Fortune 5 company in one of the fastest growing fields in the healthcare industry? This challenging role provides exposure to virtually all aspects of healthcare claims administration, from reinsurance/stop loss, data analytics, provider and broker relations, underwriting, eligibility, finance, client management and much more. Develop and hone your skills as a critical thinker, problem solver, and highly effective communicator with a meticulous eye for detail and superior organization – foundational skills that will serve you throughout your entire career. We will provide extensive training and a promising career path for the right candidate willing to learn and grow into a promising and stable line of work.


You will act as an important liaison and subject matter expert between our internal and external stakeholders and the stop loss administrators. Managing stop loss claim filings, you will reconcile and resolve discrepancies between the amount requested and the amount reimbursed by the stop loss carrier.

Required Qualifications
*Minimum of 1 year of experience in healthcare claims processing
*Minimum of 2 years of experience with the suite of Microsoft applications (particularly Excel)

Preferred Qualifications

*Ability to work independently across a matrix team in a fast-paced environment
*Strong interpersonal and communication skills (verbal and written) and pride in your work
*Experience in stop loss administration

*Exposure to a mainframe IBM AIX or AS/400 environments (i.e. "green screen", command driven platforms)


Education

*High School matriculate or GED equivalent

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

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

We anticipate the application window for this opening will close on: 03/12/2026

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

CVS Pharmacy Inc

Website: https://cvshealth.com/

Headquarter Location: Woonsocket, Rhode Island, United States

Employee Count: 10001+

Year Founded: 1963

IPO Status: Public

Last Funding Type: Post-IPO Equity

Industries: Health Care ⋅ Medical ⋅ Pharmaceutical ⋅ Retail ⋅ Sales