Medical Claims Recovery Analyst

CVS Health; Maryland; On-site; USD 25,000 - 53,000; Full time

Job summary

CVS Health is seeking a Recovery Specialist to handle overpayment recovery work, including complex refunds and provider outreach. The role emphasizes compliance, timely follow-ups, and collaboration with internal teams and vendors. An associate degree and 3+ years of claims processing experience are expected.

The position requires strong attention to detail, ability to manage multiple tasks, and effective communication across stakeholders.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ year of medical claims adjustments and/or rework experience
• 2+ year of experience working 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, including conflicting, missing, or inaccurate information, via phone and written correspondence with limited supervision
• Partner with internal business units, vendors, and liaisons to recover funds and fully allocate refunds
• Administer overpayment recovery policies and procedures, including written and phone correspondence with members, providers, and other insurers
• Manage overpayment work inventory; monitor progress and complete timely follow-ups to achieve recovery goals
• Coordinate with key business functions on escalated overpayments to drive resolution and recovery
• Use analysis and evaluation of alternatives to solve complex, non-routine recovery issues
• Use reporting to track inventory, productivity, and recovery results
• Perform claim adjustments and rework calculations across all dollar amounts using claims processing expertise
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures to support claim adjudication
• Process complex provider refunds and returned checks
• Review and interpret provider contract language to validate overpayments and support allocation of refund checks
• Deliver recovery training for less experienced team members as needed
• Handle customer service inquiries and issues assigned

Skills

Medical claims processing

Outbound calls

Customer service inquiries

Eligibility guidance

Attention to detail

Education

Associate degree

Tools

DG system claims processing

Job description

CVS Health is seeking a Recovery Specialist to handle overpayment recovery work, including complex refunds and provider outreach. The role emphasizes compliance, timely follow-ups, and collaboration with internal teams and vendors. An associate degree and 3+ years of claims processing experience are expected.

The position requires strong attention to detail, ability to manage multiple tasks, and effective communication across stakeholders.