Overpayment Recovery Specialist

CVS Health; Idaho; Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Benefits package

Job summary

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate refunds, manage overpayment inventory, and coordinate with providers and vendors. You will perform complex adjustments and ensure compliance with policies while engaging in outbound provider outreach and customer service activities.

The role requires 3+ years in medical claims processing, strong attention to detail, and the ability to manage multiple priorities 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, 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 with limited supervision.
• Partner with internal business units, vendors, and liaisons to recover funds and fully allocate refunds.
• Administer overpayment recovery policies and procedures, including written and phone correspondence with members, providers, and other insurers.
• Manage overpayment work inventory; monitor progress and complete timely follow-ups to achieve recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution and recovery.
• Use analysis and evaluation of alternatives 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 using claims processing expertise.
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review and interpret provider contract language to validate overpayments and support allocation of refund checks.
• Deliver recovery training for less experienced team members.
• Handle customer service inquiries and issues assigned.

Skills

Outbound calls

Customer service

Attention to detail

Multi-tasking

Guidelines interpretation

Education

Associate degree

Tools

DG system

Job description

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate refunds, manage overpayment inventory, and coordinate with providers and vendors. You will perform complex adjustments and ensure compliance with policies while engaging in outbound provider outreach and customer service activities.

The role requires 3+ years in medical claims processing, strong attention to detail, and the ability to manage multiple priorities in a fast-paced environment.