Overpayment Recovery Specialist

CVS Health; Clayton (NM); 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 analyst to recover and allocate overpaid dollars. You will handle complex refunds, engage with providers, and ensure adherence to compliance and policy. The role involves outbound outreach, high-volume processing, and collaboration with internal teams.

Qualified candidates have 3+ years in medical claims processing, with experience in adjustments and fast-paced environments. A 40-hour work week; eligible for CVS Health bonus programs.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework.
• 2+ years in a fast-paced, high-volume environment.
• Experience with outbound provider outreach and customer inquiries.

Responsibilities

• Review, collect, and resolve overpayment recovery items with limited supervision.
• Partner with internal units and vendors to recover funds and allocate refunds.
• Administer overpayment policies with members and providers.
• Manage inventory, track progress, and meet recovery goals.
• Coordinate escalated overpayments to drive resolution and recovery.
• Analyze alternatives to solve complex recovery issues.
• Use reports to monitor productivity and recovery results.
• Perform claim adjustments and rework calculations.
• Apply medical necessity guidelines to support adjudication.
• Process complex provider refunds and returned checks.
• Review provider contracts to validate overpayments and refunds.
• Deliver training to less experienced team members.
• Handle customer service inquiries as assigned.

Skills

Medical claims processing

Outbound provider outreach

High-volume deadline-driven work

Customer service handling (phone/email

Education

Associate degree or equivalent experience

Tools

Claims processing system

Job description

CVS Health is seeking a detail-oriented analyst to recover and allocate overpaid dollars. You will handle complex refunds, engage with providers, and ensure adherence to compliance and policy. The role involves outbound outreach, high-volume processing, and collaboration with internal teams.

Qualified candidates have 3+ years in medical claims processing, with experience in adjustments and fast-paced environments. A 40-hour work week; eligible for CVS Health bonus programs.