Overpayment Recovery Specialist

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

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a detail-oriented professional to recover and allocate overpayments. You will work with internal teams and vendors, respond to inquiries, and perform complex provider outreach to secure recoveries.

The role emphasizes compliance, accuracy, and timely follow-ups while using claims processing expertise to adjust and rework as needed. A strong focus on customer service and documentation is essential.

Qualifications

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

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 recovery policies and procedures with members and providers.
• Manage overpayment inventory and complete timely follow-ups to meet recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution.
• Use analysis to solve non-routine recovery issues and track results.
• Perform claim adjustments and rework calculations across dollar amounts.
• Apply medical necessity guidelines to support claim adjudication.

Skills

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Attention to detail

Education

Associate degree or equivalent experience

Tools

DG system

Job description

CVS Health is seeking a detail-oriented professional to recover and allocate overpayments. You will work with internal teams and vendors, respond to inquiries, and perform complex provider outreach to secure recoveries.

The role emphasizes compliance, accuracy, and timely follow-ups while using claims processing expertise to adjust and rework as needed. A strong focus on customer service and documentation is essential.