Overpayment Recovery Specialist

CVS Health; Indiana; Híbrido; USD 25.000 - 54.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Benefits package including medical,(d)

Descripción de la vacante

CVS Health is seeking a detail-oriented professional to recover and allocate overpaid dollars and manage overpayment inventory. The role includes complex refunds, outbound provider outreach, and ensuring compliance with policies and procedures.

You will analyze complex recovery issues, partner with internal teams and vendors, and use data to track progress and drive results while delivering high-quality customer service.

Formación

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework experience.
• 2+ years of experience 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.

Responsabilidades

• 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 allocate refunds.
• Administer overpayment recovery policies and procedures with members, providers, and other 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 and recovery.
• 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 using claims processing expertise.
• Apply medical necessity guidelines, 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 and support refund allocation.
• Deliver recovery training for less experienced team members as needed.
• Handle customer service inquiries and issues assigned.

Conocimientos

Medical claims processing

Medical claims adjustments

High-volume environment

Outbound calls

Customer service inquiries

Guideline interpretation

multitasking and accuracy

Educación

Associate degree or equivalent experience

Descripción del empleo

CVS Health is seeking a detail-oriented professional to recover and allocate overpaid dollars and manage overpayment inventory. The role includes complex refunds, outbound provider outreach, and ensuring compliance with policies and procedures.

You will analyze complex recovery issues, partner with internal teams and vendors, and use data to track progress and drive results while delivering high-quality customer service.