Overpayment Recovery Specialist

CVS Health; Kansas; On-site; USD 25,000 - 53,000; Full time

Job summary

CVS Health is seeking an experienced Overpayment Recovery Specialist to recover and allocate overpaid dollars, coordinating with internal teams and external vendors to secure recoveries. Compliance with policies and timely follow-ups are essential.

The role involves outbound provider outreach, detailed claim adjustments, and adherence to cost-containment guidelines during adjudication, with a focus on accuracy and scalable recovery processes.

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 with limited supervision.
• Partner with internal 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 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 as needed.
• Handle customer service inquiries and issues assigned.

Skills

Medical claims processing

Claims adjustments & rework

High-volume environment

Outbound/provider outreach

Customer service inquiries

Eligibility & benefits interpretation

Attention to detail

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking an experienced Overpayment Recovery Specialist to recover and allocate overpaid dollars, coordinating with internal teams and external vendors to secure recoveries. Compliance with policies and timely follow-ups are essential.

The role involves outbound provider outreach, detailed claim adjustments, and adherence to cost-containment guidelines during adjudication, with a focus on accuracy and scalable recovery processes.