Overpayment Recovery Specialist

CVS Health; Austin (TX); On-site; USD 25,000 - 53,000; Full time

Job summary

CVS Health in the United States is seeking an Overpayment Recovery Specialist to recover and allocate overpaid funds, including complex refunds, with providers and internal teams.

You will manage recovery workflows, follow policies, and use data analysis to track progress and drive timely recoveries. An associate degree with 3+ years of claims processing is expected, with strong attention to detail.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework.
• 2+ years in a fast-paced, deadline-driven environment.
• Experience conducting outbound provider outreach.
• Experience handling customer service inquiries by phone or written.
• Ability to interpret eligibility, coverage, and benefits guidelines.
• Strong 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 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 measures
• Process complex provider refunds and returned checks
• Review and interpret provider contract language to validate overpayments
• Deliver recovery training for less experienced team members
• Handle customer service inquiries and issues assigned

Skills

Medical claims processing

Outbound calls

Customer service

Detail oriented

Education

Associate degree or equivalent experience

Job description

CVS Health in the United States is seeking an Overpayment Recovery Specialist to recover and allocate overpaid funds, including complex refunds, with providers and internal teams.

You will manage recovery workflows, follow policies, and use data analysis to track progress and drive timely recoveries. An associate degree with 3+ years of claims processing is expected, with strong attention to detail.