Overpayment Recovery Specialist

CVS Health; United States; Remote; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an experienced Overpayment Recovery Specialist to recover and allocate overpaid dollars across complex refunds. You will coordinate with vendors and internal teams, research recovery inquiries, and conduct provider outreach to secure recoveries while maintaining compliance with company policies.

You will review and resolve excess payment items, manage recovery work inventory, and help drive timely resolution.

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.
• Experience conducting outbound calls, including provider outreach.
• Experience handling customer service inquiries via phone and/or written correspondence.
• Ability to interpret and apply guidelines related to eligibility, coverage, and benefits.
• Demonstrated ability to manage multiple assignments with a high degree of accuracy and attention to detail.

Responsibilities

• Review, collect, and resolve overpayment recovery items via phone and written correspondence.
• Partner with internal business units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment policies and procedures, including communications with members, providers, and insurers.
• Manage overpayment work inventory and follow up to achieve recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and support refund allocation.
• Deliver recovery training for less experienced team members.
• Handle customer service inquiries and issues.

Skills

Medical claims processing

Outbound calls

Customer service

Attention to detail

Guidelines interpretation

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 across complex refunds. You will coordinate with vendors and internal teams, research recovery inquiries, and conduct provider outreach to secure recoveries while maintaining compliance with company policies.

You will review and resolve excess payment items, manage recovery work inventory, and help drive timely resolution.