Medical Claims Recovery & Refunds Analyst

CVS Health; Illinois; 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 in Illinois seeks a detail‑oriented Recovery Specialist to recover overpaid dollars, manage overpayment inventory, and coordinate with vendors and providers. The role requires outbound provider outreach and adherence to compliance standards.

You will review and resolve recovery items, perform claim adjustments, track progress with reporting, and support team training. The position offers full‑time hours and a competitive hourly pay range with bonus eligibility.

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 and procedures with members, providers, and other insurers.
• Manage overpayment work inventory; monitor progress and follow up to achieve recovery goals.
• Coordinate with key functions on escalated overpayments to drive resolution and recovery.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework across all dollar amounts.
• Apply medical necessity guidelines to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and support refund allocation.
• Deliver recovery training for less experienced team members.
• Handle customer service inquiries and issues.

Skills

Medical claims processing

Claims adjustments/rework

Fast-paced environment

Outbound provider outreach

Customer service inquiries

Eligibility/coverage guidelines

Attention to detail

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health in Illinois seeks a detail‑oriented Recovery Specialist to recover overpaid dollars, manage overpayment inventory, and coordinate with vendors and providers. The role requires outbound provider outreach and adherence to compliance standards.

You will review and resolve recovery items, perform claim adjustments, track progress with reporting, and support team training. The position offers full‑time hours and a competitive hourly pay range with bonus eligibility.