Overpayment Recovery Specialist

CVS Health; California City (CA); 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 a detail-oriented professional to recover and allocate overpaid dollars. The role involves complex, non-routine refunds, outbound provider outreach, and adherence to compliance and company policies.

You will work with cross-functional teams to secure recoveries and maintain accurate records. Ideal candidates have 3+ years in medical claims processing and 2+ years in adjustments, in a fast-paced 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 environment.
• Experience with outbound calls to providers.
• Experience handling customer service inquiries by phone or written correspondence.
• 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.
• Partner with internal units and vendors to recover funds and allocate refunds.
• Administer overpayment recovery policies and communicate with members, providers, and insurers.
• Manage overpayment work inventory and follow up to meet recovery goals.
• Coordinate escalated overpayments to drive resolution and recovery.
• Analyze alternatives to solve complex recovery issues.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Guidelines interpretation

Education

Associate degree

Tools

DG system

Job description

CVS Health is seeking a detail-oriented professional to recover and allocate overpaid dollars. The role involves complex, non-routine refunds, outbound provider outreach, and adherence to compliance and company policies.

You will work with cross-functional teams to secure recoveries and maintain accurate records. Ideal candidates have 3+ years in medical claims processing and 2+ years in adjustments, in a fast-paced environment.