Overpayment Recovery Specialist

CVS Health; San Francisco (CA); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Bonus potential

Comprehensive benefits

Paid time off

Retirement savings options

Wellness program

Job summary

CVS Health is seeking an experienced Overpayment Recovery Specialist to recover and allocate overpaid dollars, including complex refunds. You will partner with internal teams and vendors, review recovery items, and respond to inquiries while ensuring compliance.

You'll manage overpayment inventory, perform provider outreach (outbound calls), and apply medical necessity guidelines to support claim adjudication. This full-time role offers comprehensive benefits and bonus opportunities.

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.
• Outbound calls experience with providers.
• Customer service inquiries via phone or written correspondence.
• Ability to interpret guidelines related to eligibility, coverage, and benefits.
• Strong attention to detail with multi-tasking.

Responsibilities

• Review, collect, and resolve overpayment recovery items.
• Coordinate with internal units and vendors to recover funds.
• Administer overpayment recovery policies and communications.
• Manage overpayment work inventory and timely follow-ups.
• Escalate overpayments to drive resolution.
• Use analysis to solve complex recovery issues.
• Use reporting to track inventory, productivity, and results.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments.
• Deliver training to less experienced team members.
• Handle customer service inquiries related to recoveries.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Eligibility & benefits guidelines

Attention to detail

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking an experienced Overpayment Recovery Specialist to recover and allocate overpaid dollars, including complex refunds. You will partner with internal teams and vendors, review recovery items, and respond to inquiries while ensuring compliance.

You'll manage overpayment inventory, perform provider outreach (outbound calls), and apply medical necessity guidelines to support claim adjudication. This full-time role offers comprehensive benefits and bonus opportunities.