Overpayment Recovery Analyst — Claims & Refunds

CVS Health; Central City (KY); Sur place; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Résumé du poste

CVS Health is seeking a detail-oriented professional to recover and allocate overpaid dollars, including complex refunds. You will manage overpayment inventory, engage with providers and internal teams, and ensure compliance in every step of the recovery process.

The role involves outbound calls, policy administration, and driving timely recoveries while maintaining high accuracy. A strong background in claims processing and a commitment to quality are essential.

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

Responsabilités

• Review, collect, and resolve overpayment recovery items via phone and written correspondence with limited supervision
• Partner with internal business 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 complete timely follow-ups to achieve recovery goals
• Coordinate with key business 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 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

Connaissances

Medical claims processing

Claims adjustments

Outbound provider outreach

Customer service

Attention to detail

Fast-paced environment

Formation

Associate degree or equivalent

Description du poste

CVS Health is seeking a detail-oriented professional to recover and allocate overpaid dollars, including complex refunds. You will manage overpayment inventory, engage with providers and internal teams, and ensure compliance in every step of the recovery process.

The role involves outbound calls, policy administration, and driving timely recoveries while maintaining high accuracy. A strong background in claims processing and a commitment to quality are essential.