Overpayment Recovery Specialist

CVS Health; City of Albany (NY); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Paid time off

Job summary

CVS Health is seeking a detail-oriented Overpayment Recovery Specialist to review, collect, and allocate refunds from complex overpayments. You will collaborate with internal teams and vendors to secure recoveries while ensuring compliance with company policies.

The role involves outbound provider outreach, timely follow-ups, and accurate reconciliation of adjustments across all dollar amounts. A strong eye for data and customer service mindset are essential for success.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ years of 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.
• Partner with internal units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment policies and procedures with members, providers, and insurers.
• Monitor overpayment work inventory and complete timely follow-ups to meet recovery goals.
• Coordinate with key functions on escalated overpayments to drive resolution.
• Analyze and evaluate alternatives to solve complex recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework calculations across all dollar amounts.

Skills

Medical claims processing

Outbound calls

Customer service

Eligibility/benefits 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 to review, collect, and allocate refunds from complex overpayments. You will collaborate with internal teams and vendors to secure recoveries while ensuring compliance with company policies.

The role involves outbound provider outreach, timely follow-ups, and accurate reconciliation of adjustments across all dollar amounts. A strong eye for data and customer service mindset are essential for success.