Overpayment Recovery Specialist

CVS Health; Yuma (AZ); 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

Job summary

CVS Health is hiring for an Overpayment Recovery Specialist in the United States. This role focuses on recovering and allocating overpaid dollars, handling complex refunds, and ensuring compliance with policies.

You will collaborate with internal teams, vendors, and insurers to secure recoveries, manage inventory, and respond to inquiries. A candidate with strong attention to detail and prior claims experience will excel.

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

Responsibilities

• Review, collect, and resolve overpayment recovery items via phone and written correspondence.
• Partner with internal 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 and complete timely follow-ups to meet recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution and recovery.
• Use analysis and evaluation to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework calculations across dollar amounts using claims processing expertise.
• Apply medical necessity guidelines, verify eligibility, identify discrepancies, and support cost containment for adjudication.
• Process complex provider refunds and returned checks.
• Review and interpret provider contract language to validate overpayments and support refunds.

Skills

Medical claims processing

Claims adjustments

Outbound calls

Customer service

Eligibility interpretation

Attention to detail

Education

Associate degree or equivalent

Tools

DG system claims processing

Job description

CVS Health is hiring for an Overpayment Recovery Specialist in the United States. This role focuses on recovering and allocating overpaid dollars, handling complex refunds, and ensuring compliance with policies.

You will collaborate with internal teams, vendors, and insurers to secure recoveries, manage inventory, and respond to inquiries. A candidate with strong attention to detail and prior claims experience will excel.