Overpayment Recovery Specialist

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced overpayment recovery specialist to recover and allocate refunds, manage overpayment inventory, and coordinate with vendors and internal teams. The role includes outbound provider outreach, complex claim adjustments, and applying medical necessity guidelines to support adjudication.

Strong attention to detail and a commitment to compliance are essential. The position offers a full-time schedule with 40 hours per week in a standard U.S.

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.
• Outbound calls including provider outreach.
• Handling customer service inquiries via phone or written correspondence.
• Ability to interpret eligibility, coverage and benefits guidelines.

Responsibilities

• Review, collect, and resolve overpayment recovery items with limited supervision.
• Partner with internal units, vendors, and liaisons to recover funds.
• Administer overpayment policies with members, providers, and insurers.
• Manage overpayment work inventory and ensure timely follow-ups.
• Coordinate escalated overpayments to drive resolution and recovery.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity and results.
• Perform claim adjustments and rework calculations using processing expertise.
• Apply medical necessity guidelines to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments.
• Deliver recovery training for teammates as needed.
• Handle customer service inquiries and issues.

Skills

Claims processing

Claims adjustments

High volume work

Outbound calls

Customer service

Eligibility interpretation

Education

Associate degree

Tools

DG system

Claims processing software

Job description

CVS Health is seeking an experienced overpayment recovery specialist to recover and allocate refunds, manage overpayment inventory, and coordinate with vendors and internal teams. The role includes outbound provider outreach, complex claim adjustments, and applying medical necessity guidelines to support adjudication.

Strong attention to detail and a commitment to compliance are essential. The position offers a full-time schedule with 40 hours per week in a standard U.S.