Overpayment Recovery & Claims Specialist

CVS Health; Montgomery (AL); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a detail-oriented Overpayment Recovery Specialist to review and allocate refunds, conduct provider outreach, and ensure compliance. You will handle complex recoveries, collaborate with vendors and internal teams, and maintain accurate tracking of inventory and performance metrics.

The role emphasizes attention to detail, strong communication, and the ability to work in a high-volume environment.

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 with limited supervision.
• Partner with internal business units, vendors, and liaisons to recover funds and 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 follow up 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.
• Process complex provider refunds and returned checks.
• Review and interpret provider contract language to validate overpayments and support refund allocation.
• Deliver recovery training for less experienced team members as needed.

Skills

Medical claims processing

Claims adjustments/rework

Outbound calls

Customer service inquiries

Guidelines interpretation (eligibility

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a detail-oriented Overpayment Recovery Specialist to review and allocate refunds, conduct provider outreach, and ensure compliance. You will handle complex recoveries, collaborate with vendors and internal teams, and maintain accurate tracking of inventory and performance metrics.

The role emphasizes attention to detail, strong communication, and the ability to work in a high-volume environment.