Overpayment Recovery Specialist

CVS Health; Michigan; Hybrid; USD 25,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health in Michigan is seeking a claims recovery specialist to recover and allocate overpaid dollars, including complex refunds. You will collaborate with internal teams and third-party vendors to secure recoveries and ensure adherence to policies and procedures.

The role involves outbound provider outreach, processing adjustments, and applying medical necessity guidelines to support claim adjudication. A related associate degree or equivalent experience is preferred, with 3+ years of claims

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 or written correspondence.
• Ability to interpret and apply guidelines related to eligibility, coverage, and benefits.

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 policies and procedures with members, providers, and other insurers.
• Monitor inventory and complete timely follow-ups to achieve recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution.
• Use analysis to solve complex recovery issues and track results.
• Perform claim adjustments and rework calculations across dollar amounts.
• Apply medical necessity guidelines to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and refund allocations.
• Deliver recovery training to less experienced team members.
• Handle customer service inquiries as assigned.

Skills

Medical claims processing

Claims adjustments

Fast-paced environment

Outbound calls

Customer service inquiries

Interpret guidelines

Education

Associate degree or equivalent

Job description

CVS Health in Michigan is seeking a claims recovery specialist to recover and allocate overpaid dollars, including complex refunds. You will collaborate with internal teams and third-party vendors to secure recoveries and ensure adherence to policies and procedures.

The role involves outbound provider outreach, processing adjustments, and applying medical necessity guidelines to support claim adjudication. A related associate degree or equivalent experience is preferred, with 3+ years of claims