Healthcare Overpayment Recovery Analyst

CVS Health; Clayton (NC); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a detail-focused Overpayment Recovery Specialist to manage complex refunds and allocate payments. You will collaborate with internal teams and vendors to recover funds, conducting outbound outreach to providers while ensuring compliance with policies and procedures.

The role requires 3+ years in medical claims processing, strong attention to accuracy, and the ability to conduct multi-tasking in a fast-paced environment.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework experience.
• 2+ years in a fast-paced, deadline-driven, high-volume environment.
• Experience conducting outbound calls to providers.
• Experience handling customer service inquiries via phone or written correspondence.
• Ability to interpret and apply guidelines related to eligibility, coverage, and benefits.
• Demonstrated ability to manage multiple assignments with accuracy and 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 and follow up to achieve recovery goals.
• Coordinate with key business 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 using claims processing expertise.
• Apply medical necessity guidelines and verify eligibility to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contracts to validate overpayments and refunds.
• Deliver recovery training for less experienced team members.
• Handle customer service inquiries and issues as assigned.

Skills

Medical claims processing

Claims adjustments/rework

Outbound provider outreach

Customer service queries

Eligibility & benefits interpretation

Attention to detail

High-volume environment

Education

Associate degree

Tools

Claims processing systems

Job description

CVS Health is seeking a detail-focused Overpayment Recovery Specialist to manage complex refunds and allocate payments. You will collaborate with internal teams and vendors to recover funds, conducting outbound outreach to providers while ensuring compliance with policies and procedures.

The role requires 3+ years in medical claims processing, strong attention to accuracy, and the ability to conduct multi-tasking in a fast-paced environment.