- CVS Health (Trenton, NJ)
- …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 ... a subsidiary of CVS Health as the Manager of Stop Loss /Reinsurance Operations . In this...claims , eligibility, plan setup, implementation) or related field; stop loss /reinsurance experience highly preferred * Progressive… more
- Highmark Health (Trenton, NJ)
- …making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or ... client reports submitted to the organization, efficiency of claim operations , and adequacy of systems and procedures. + Approves...terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role.… more
- CVS Health (Trenton, NJ)
- …drugs, complex PBM vendors, and high-profile clients). + Reconcile aging reports and stop loss inquiries. + Meet key performance metrics including production, ... the **Meritain Health PBM** ( _Pharmacy Benefit Manager_ ) ** Operations Team** and is responsible for processing PBM vendor...and is responsible for processing PBM vendor invoices and claims . The **PBM Invoice Processor** is assigned a set… more
- Amazon (New York, NY)
- …funding and scoring performance compared to plan expectations. -Complete the evaluation of stop - loss coverage and manage third party vendors -Analyze and develop ... of actuarial reserving, forecasting and medical economics -Expertise in working with medical claims data and using programming languages such as SQL, R, SAS, Python,… more
- Northwell Health (New York, NY)
- …TPA account management for renewal distribution and negotiations with the plan vendors ( Stop loss , PBM, etc *Additional Salary Detail The salary range and/or ... progressively related sales experience including experience with products, services, operations , customer service, marketing and sales techniques. *May have some… more