Medical Claims Recovery Specialist

CVS Health; North Carolina; On-site; USD 26,000 - 54,000; 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 motivated professional to join our team as an Overpayment Recovery Specialist. You will recover and allocate overpaid dollars, handle complex refunds, and work with internal teams and vendors to secure recoveries.

Responsibilities include reviewing recovery items, conducting provider outreach via outbound calls, and applying guidelines to determine eligibility and coverage. The role demands accuracy, strong communication, and the ability to manage multiple tasks in a

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 and vendors to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures with members, providers, and insurers.
• Manage overpayment work inventory and follow up to achieve recovery goals.
• Coordinate with key functions on escalated overpayments to drive resolution.
• Use analysis to solve complex, non-routine recovery issues.
• Utilize reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework calculations 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 refunds.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Guideline interpretation

Multitasking

Education

Associate degree or equivalent

Job description

CVS Health is seeking a motivated professional to join our team as an Overpayment Recovery Specialist. You will recover and allocate overpaid dollars, handle complex refunds, and work with internal teams and vendors to secure recoveries.

Responsibilities include reviewing recovery items, conducting provider outreach via outbound calls, and applying guidelines to determine eligibility and coverage. The role demands accuracy, strong communication, and the ability to manage multiple tasks in a