Overpayment Recovery Specialist

CVS Health; Washington; Hybride; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Healthcare benefits

Paid time off

Retirement plan

Résumé du poste

CVS Health is hiring for an Overpayment Recovery role in the United States, focusing on recovering and allocating overpaid dollars and handling complex refunds. You’ll partner with internal teams and external vendors to secure recoveries while ensuring compliance with policies and procedures.

The position requires experienced medical claims processing, provider outreach, and strong attention to detail in a fast-paced environment. It offers a full-time schedule with benefits and bonus eligibility.

Qualifications

• 3+ years of medical claims processing experience
• 2+ year of medical claims adjustments and/or rework experience
• 2+ year of experience working 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

Responsabilités

• Review, collect, and resolve overpayment recovery items via phone and written correspondence with limited supervision
• Partner with internal units, vendors, and liaisons to recover funds and allocate refunds
• Administer overpayment recovery policies and procedures with members, providers, and insurers
• Manage overpayment work inventory; monitor progress and follow up to meet 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
• Perform claim adjustments and rework calculations across all dollar amounts
• Apply medical necessity guidelines, verify eligibility, and support claim adjudication
• Process complex provider refunds and returned checks
• Review provider contracts to validate overpayments and refund allocation
• Deliver recovery training for less experienced team members
• Handle customer service inquiries and issues assigned

Connaissances

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service

Eligibility guidelines

Attention to detail

Formation

Associate degree or equivalent experience

Description du poste

CVS Health is hiring for an Overpayment Recovery role in the United States, focusing on recovering and allocating overpaid dollars and handling complex refunds. You’ll partner with internal teams and external vendors to secure recoveries while ensuring compliance with policies and procedures.

The position requires experienced medical claims processing, provider outreach, and strong attention to detail in a fast-paced environment. It offers a full-time schedule with benefits and bonus eligibility.