Overpayment Recovery Specialist

CVS Health; West Virginia; 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 seeking a dedicated specialist to recover and allocate overpaid dollars, coordinating with providers and internal teams to secure recoveries while upholding compliance and quality standards.

You will manage complex refunds, monitor recovery progress, and train less experienced staff in a fast-paced, high-volume environment. Strong attention to detail and communication with partners are essential.

Qualifications

• 3+ years of medical claims processing experience.
• 2+ years of medical claims adjustments and/or rework experience.
• 2+ years of experience 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 with limited supervision.
• Partner with internal business units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures with members, providers, and other insurers.
• Manage overpayment work inventory; monitor progress and complete timely follow-ups to achieve recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution and recovery.
• Use analysis to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework across all dollar amounts using claims processing expertise.
• Apply medical necessity guidelines to support claim adjudication.
• Review provider contracts to validate overpayments.

Skills

Medical claims processing

Claims adjustments

High-volume environment

Outbound calls

Customer service inquiries

Guidelines interpretation

Multitasking

Education

Associate degree or equivalent

Tools

DG system claims processing

Job description

CVS Health is seeking a dedicated specialist to recover and allocate overpaid dollars, coordinating with providers and internal teams to secure recoveries while upholding compliance and quality standards.

You will manage complex refunds, monitor recovery progress, and train less experienced staff in a fast-paced, high-volume environment. Strong attention to detail and communication with partners are essential.