Health Claims Overpayment Recovery Analyst

CVS Health; Sacramento (CA); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Coverage

Retirement Savings Options

Wellness Programs

Job summary

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate overpaid dollars in a fast-paced environment. You will conduct outbound provider outreach, review complex recovery items, and ensure compliance with policies and procedures while coordinating with internal teams and vendors.

The role requires several years of medical claims experience, strong attention to detail, and the ability to manage multiple tasks.

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 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 and procedures with members, providers, and other insurers
• Manage overpayment work inventory; monitor progress and complete timely follow-ups
• Coordinate with key functions on escalated overpayments to drive resolution
• Use analysis to solve complex, non-routine recovery issues
• Use reporting to track inventory, productivity, and recovery results
• Perform claim adjustments and rework calculations across dollar amounts

Skills

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Attention to detail

Education

Associate degree or equivalent experience

Tools

DG system

Job description

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate overpaid dollars in a fast-paced environment. You will conduct outbound provider outreach, review complex recovery items, and ensure compliance with policies and procedures while coordinating with internal teams and vendors.

The role requires several years of medical claims experience, strong attention to detail, and the ability to manage multiple tasks.