Overpayment Recovery Specialist

CVS Health; Springfield (IL); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings plan

Wellness programs

Job summary

CVS Health in Springfield, IL is seeking a detail‑minded professional to recover and allocate overpaid dollars. You will work with internal teams and external vendors, responding to inquiries and coordinating provider outreach to secure recoveries.

The role requires 3+ years of claims processing experience, 2+ years in adjustments, and the ability to handle multiple tasks in a fast-paced environment. Benefit-rich, full-time employment with competitive pay.

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 environment.
• Experience conducting outbound calls to providers.
• Experience handling customer service inquiries by phone or written correspondence.
• Ability to interpret eligibility, coverage, and benefits guidelines.
• Ability to manage multiple assignments with high 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 policies and communicate with members, providers, and insurers.
• Manage recovery work inventory and follow up to meet goals.
• Coordinate escalated overpayments with key business functions.
• Use analysis to solve complex recovery issues and track results.
• Perform claim adjustments and rework calculations on dollar amounts.
• Apply medical necessity guidelines to determine coverage and adjudication.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Provider outreach

Customer service by phone

Attention to detail

Multi-tasking

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health in Springfield, IL is seeking a detail‑minded professional to recover and allocate overpaid dollars. You will work with internal teams and external vendors, responding to inquiries and coordinating provider outreach to secure recoveries.

The role requires 3+ years of claims processing experience, 2+ years in adjustments, and the ability to handle multiple tasks in a fast-paced environment. Benefit-rich, full-time employment with competitive pay.