Overpayment Recovery Specialist

CVS Health; Texas; On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is hiring for an Overpayment Recovery Specialist in Texas. You will recover and allocate overpaid dollars, conduct provider outreach, and ensure compliance with policies. The role involves complex investigations, outbound calls, and collaboration across internal teams.

The position requires 3+ years of medical claims processing, with experience in adjustments and a fast-paced environment. Eligible for bonus and comprehensive benefits.

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.
• Outbound calls to providers.
• Handling customer inquiries by phone or written correspondence.
• Interpretation of eligibility, coverage, and benefits.
• Strong attention to detail and ability to multitask.

Responsibilities

• Review and resolve overpayment recovery items via phone and written correspondence.
• Partner with internal teams and vendors to recover funds and allocate refunds.
• Administer overpayment policies and procedures for members, providers, and insurers.
• Monitor recovery inventory and perform timely follow-ups to meet goals.
• Coordinate escalated overpayments with key business functions for resolution.
• Analyze and evaluate alternatives to solve complex recovery issues.
• Use reports to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework across all dollar amounts.
• Apply medical necessity guidelines to support adjudication.

Skills

Medical claims processing

Provider outreach

Customer service

Attention to detail

Multi-tasking

Education

Associate degree or equivalent experience

Job description

CVS Health is hiring for an Overpayment Recovery Specialist in Texas. You will recover and allocate overpaid dollars, conduct provider outreach, and ensure compliance with policies. The role involves complex investigations, outbound calls, and collaboration across internal teams.

The position requires 3+ years of medical claims processing, with experience in adjustments and a fast-paced environment. Eligible for bonus and comprehensive benefits.