Overpayment Recovery Specialist

CVS Health; Maryland City (MD); 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 recovery specialist to help recover and allocate overpaid dollars. You will handle complex refunds, work with vendors and internal teams, and ensure compliance with policies.

The role involves outbound provider outreach, researching inquiries, and performing claim adjustments using processing expertise. You’ll operate in a fast-paced, high-volume environment with a focus on accuracy and timely resolution.

Qualifications

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

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 recovery policies and procedures with members, providers, and insurers.
• Manage overpayment work inventory; monitor progress and follow up to achieve recovery goals.
• Coordinate with key business functions on escalated overpayments for resolution.
• Use analysis to solve complex, non-routine recovery issues.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Guideline interpretation

Education

Associate degree

Tools

DG system

Claims processing software

Job description

CVS Health is seeking a recovery specialist to help recover and allocate overpaid dollars. You will handle complex refunds, work with vendors and internal teams, and ensure compliance with policies.

The role involves outbound provider outreach, researching inquiries, and performing claim adjustments using processing expertise. You’ll operate in a fast-paced, high-volume environment with a focus on accuracy and timely resolution.