Overpayment Recovery & Claims Specialist

CVS Health; Bastrop (LA); 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 is seeking an overpayment recovery specialist to recover and allocate funds from overpayments. You will engage with providers and internal teams to secure recoveries while ensuring compliance with policies and procedures.

Role requires 3+ years in medical claims processing and 2+ years in adjustments or rework, with strong communication for outbound provider outreach and customer inquiries. 40-hour weeks with standard benefits are provided.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework experience.
• 2+ years 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 business functions on escalated overpayments to drive resolution.
• 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.
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and refund allocations.
• Deliver recovery training for less experienced team members.
• Handle customer service inquiries and issues as assigned.

Skills

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Attention to detail

Multi-tasking

Education

Associate degree

Job description

CVS Health is seeking an overpayment recovery specialist to recover and allocate funds from overpayments. You will engage with providers and internal teams to secure recoveries while ensuring compliance with policies and procedures.

Role requires 3+ years in medical claims processing and 2+ years in adjustments or rework, with strong communication for outbound provider outreach and customer inquiries. 40-hour weeks with standard benefits are provided.