Claims Recovery & Refunds Specialist

CVS Health; Florida; Hybrid; USD 25,000 - 53,000; Full time

Job summary

CVS Health in Florida is seeking a full-time Overpayment Recovery Specialist to recover and allocate overpaid dollars, perform complex provider outreach, and ensure compliance with policies. You will review items, coordinate with internal units and vendors, and apply guidelines to support claim adjudication.

The role requires 3+ years of claims processing experience in a fast-paced environment, outbound calling, and strong attention to detail.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ year of medical claims adjustments and/or rework experience.
• 2+ year of experience in a fast paced, deadline-driven, high-volume environment.
• Experience conducting outbound calls, including provider outreach.
• Experience handling customer service inquiries via phone and/or written correspondence.
• Ability to interpret and apply guidelines related to eligibility, coverage, and benefits.
• Demonstrated ability to manage multiple assignments with a high degree of accuracy and attention to detail.

Responsibilities

• Review, collect, and resolve overpayment recovery items via phone and written correspondence.
• Partner with internal units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment recovery policies with members, providers, and insurers.
• Manage overpayment work inventory; monitor progress and follow up to hit recovery goals.
• Coordinate escalated overpayments with key functions to drive resolution and recovery.
• Use analysis to solve complex, non-routine recovery issues and track results.
• Perform claim adjustments and rework calculations across dollar amounts.
• Apply medical necessity guidelines and verify eligibility for adjudication.
• Process complex provider refunds and reviewed contract language.
• Deliver recovery training to junior team members.
• Handle customer service inquiries.

Skills

Medical claims processing

Claims adjustments

Fast-paced environment

Outbound calls

Customer service

Eligibility guidelines

Attention to detail

Independent decision-making

Education

Associate degree or equivalent experience

Job description

CVS Health in Florida is seeking a full-time Overpayment Recovery Specialist to recover and allocate overpaid dollars, perform complex provider outreach, and ensure compliance with policies. You will review items, coordinate with internal units and vendors, and apply guidelines to support claim adjudication.

The role requires 3+ years of claims processing experience in a fast-paced environment, outbound calling, and strong attention to detail.