Overpayment Recovery Analyst (Healthcare Claims)

CVS Health; Utah; Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus/incentive program

Job summary

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate refunds, including complex, non-routine cases, while ensuring compliance with policies. You’ll collaborate with providers, members and internal teams to secure recoveries and maintain accurate overpayment inventories.

The role requires 3+ years of medical claims processing, 2+ years of adjustments or rework, and proven experience in a fast-paced environment with outbound provider outreach.

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

Provider outreach

Data accuracy

Customer service

Attention to detail

Multi-tasking

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate refunds, including complex, non-routine cases, while ensuring compliance with policies. You’ll collaborate with providers, members and internal teams to secure recoveries and maintain accurate overpayment inventories.

The role requires 3+ years of medical claims processing, 2+ years of adjustments or rework, and proven experience in a fast-paced environment with outbound provider outreach.