Overpayment Recovery Specialist

CVS Health; Oklahoma City (OK); Presencial; USD 25.000 - 53.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Descripción de la vacante

CVS Health in Oklahoma City seeks a detail-oriented Recovery Specialist to oversee overpayment recovery and refunds. You will work with providers, members, and insurers to recover funds, allocate refunds, and ensure adherence to policies and compliance standards.

The role requires 3+ years of medical claims processing, strong accuracy, and experience with high-volume environments. Outbound outreach and effective communication are essential for success in this busy team.

Formación

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments 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 by phone or written correspondence.
• Ability to interpret guidelines related to eligibility, coverage, and benefits.
• Demonstrated ability to manage multiple assignments with a high degree of accuracy and attention to detail.

Responsabilidades

• 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 with members, providers, and insurers.
• Manage overpayment work inventory; track progress and follow up to meet goals.
• Coordinate escalated overpayments with key business functions to drive resolution.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and outcomes.
• Perform claim adjustments and rework calculations across all dollar amounts.
• Apply medical necessity guidelines to determine coverage and eligibility.
• Process complex provider refunds and returned checks.
• Review provider contracts to validate overpayments and refund allocations.
• Deliver recovery training for less experienced team members as needed.
• Handle customer service inquiries and issues.

Conocimientos

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Attention to detail

Communication skills

Educación

Associate degree or equivalent experience

Descripción del empleo

CVS Health in Oklahoma City seeks a detail-oriented Recovery Specialist to oversee overpayment recovery and refunds. You will work with providers, members, and insurers to recover funds, allocate refunds, and ensure adherence to policies and compliance standards.

The role requires 3+ years of medical claims processing, strong accuracy, and experience with high-volume environments. Outbound outreach and effective communication are essential for success in this busy team.