Stop Loss Claims Operations Manager, Remote

mbursements. 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 settingPreferred Qualifications
• Prior experience managing large teams

• Medical Claims Operations exposure

Education
bachelor's degree preferred/specialized training/relevant professional qualification.Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$54,300.00 - $159,120.00This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 01/20/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.