Overpayment Recovery & Claims Specialist

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

Job summary

CVS Health is seeking a dedicated professional to recover and allocate overpaid dollars, handling complex refunds and outreach to providers. You will ensure compliance with policies and contribute to timely recoveries in a fast-paced environment.

The role involves reviewing recovery items, coordinating with internal teams and vendors, and performing detailed analyses to optimize outcomes. A BS/AS degree or equivalent experience is preferred, with strong attention to detail and communication

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 with limited supervision
• Partner with internal units, vendors, and liaisons to recover funds and allocate refunds
• Administer overpayment recovery policies and procedures with members, providers, and insurers
• Manage overpayment work inventory; monitor progress and perform timely follow-ups
• Coordinate with key 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 and verify eligibility to support claim adjudication
• Process complex provider refunds and returned checks
• Review provider contract language to validate overpayments and refund allocation
• Deliver recovery training for less experienced team members
• Handle customer service inquiries and issues

Skills

Medical claims processing

Medical claims adjustments

Outbound calls

Customer service (phone/written)

Guideline interpretation

Attention to detail

Multi-tasking

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a dedicated professional to recover and allocate overpaid dollars, handling complex refunds and outreach to providers. You will ensure compliance with policies and contribute to timely recoveries in a fast-paced environment.

The role involves reviewing recovery items, coordinating with internal teams and vendors, and performing detailed analyses to optimize outcomes. A BS/AS degree or equivalent experience is preferred, with strong attention to detail and communication