Overpayment Recovery Specialist

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

Benefits offered by this job

Bonus program

Benefits package

Job summary

CVS Health is seeking a skilled Overpayment Recovery Specialist to recover and allocate overpaid dollars, including complex refunds. You will manage recovery inventory, collaborate with vendors, and outreach to providers to secure recoveries while ensuring compliance with company policies.

This full-time role involves outbound calls, detailed analysis, and adherence to medical claims processing guidelines. The position offers a comprehensive benefits package and competitive pay, with a typical

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 and vendors to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures with members, providers, and insurers.
• Manage overpayment work inventory and follow up to achieve recovery goals.
• Coordinate with key functions on escalated overpayments for resolution.
• Use analysis to solve complex recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework calculations across all dollar amounts.
• Apply medical necessity guidelines to determine coverage and support adjudication.
• Process complex provider refunds and returned checks.
• Review provider contracts to validate overpayments and refunds.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Eligibility & benefits

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a skilled Overpayment Recovery Specialist to recover and allocate overpaid dollars, including complex refunds. You will manage recovery inventory, collaborate with vendors, and outreach to providers to secure recoveries while ensuring compliance with company policies.

This full-time role involves outbound calls, detailed analysis, and adherence to medical claims processing guidelines. The position offers a comprehensive benefits package and competitive pay, with a typical