Overpayment Recovery Specialist

CVS Health; Arizona; Hybrid; 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 in Arizona to recover and allocate overpaid dollars, including complex refunds. The role involves outreach to providers and internal teams to secure recoveries while ensuring compliance and policy alignment.

You will review recovery items, manage inventory, and perform complex calculations across dollar amounts using claims processing expertise. Strong communication and multi-tasking are essential to succeed.

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.
• Partner with internal business units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures with members and providers.
• 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 and verify eligibility to support adjudication.
• Process complex provider refunds and returned checks.

Skills

Medical claims processing

Claims adjustments

Outbound calling

Customer service

Eligibility interpretation

Attention to detail

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a detail-oriented Overpayment Recovery Specialist in Arizona to recover and allocate overpaid dollars, including complex refunds. The role involves outreach to providers and internal teams to secure recoveries while ensuring compliance and policy alignment.

You will review recovery items, manage inventory, and perform complex calculations across dollar amounts using claims processing expertise. Strong communication and multi-tasking are essential to succeed.