Overpayment Recovery Specialist

CVS Health; Missouri; Sur place; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Résumé du poste

CVS Health in the United States seeks an Overpayment Recovery Specialist to recover and allocate refunds, including complex, non-routine cases. You will collaborate with internal teams and vendors, perform provider outreach (outbound calls) and ensure all work aligns with compliance and company policies.

Key duties include reviewing recovery items, maintaining inventory, processing claim adjustments, applying medical necessity guidelines, and delivering training to junior staff.

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.

Responsabilités

• 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 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.
• 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 dollar amounts.
• Apply medical necessity guidelines to determine coverage and eligibility.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and refunds.
• Deliver recovery training for less experienced team members.

Connaissances

Medical claims processing

Outbound calls

Provider outreach

Customer service

Attention to detail

Formation

Associate degree or equivalent experience

Outils

DG system

Description du poste

CVS Health in the United States seeks an Overpayment Recovery Specialist to recover and allocate refunds, including complex, non-routine cases. You will collaborate with internal teams and vendors, perform provider outreach (outbound calls) and ensure all work aligns with compliance and company policies.

Key duties include reviewing recovery items, maintaining inventory, processing claim adjustments, applying medical necessity guidelines, and delivering training to junior staff.