Medical Claims Recovery Analyst

CVS Health; Lorida (FL); 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

Job summary

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate overpaid dollars, manage recovery inventory, and conduct provider outreach to secure recoveries. You will ensure compliance with company policies, perform complex calculations, and apply medical necessity guidelines to support adjudication.

The role requires 3+ years of medical claims processing, 2+ years of adjustments, and a strong ability to work 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, 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 accuracy and attention to detail.

Responsibilities

• Review, collect, and resolve overpayment recovery items with limited supervision.
• Partner with internal units and vendors to recover funds and allocate refunds.
• Administer overpayment recovery policies, including communications with members, providers, and insurers.
• Monitor recovery inventory and complete timely follow-ups to meet recovery goals.
• Coordinate with key functions on escalated overpayments to drive resolution.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service inquiries

Guidelines interpretation

Multi-tasking

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate overpaid dollars, manage recovery inventory, and conduct provider outreach to secure recoveries. You will ensure compliance with company policies, perform complex calculations, and apply medical necessity guidelines to support adjudication.

The role requires 3+ years of medical claims processing, 2+ years of adjustments, and a strong ability to work in a fast-paced environment.