Overpayment Recovery Specialist - Medical Claims

CVS Health; Montana; Hybrid; USD 25,000 - 53,000; Full time

Job summary

CVS Health in Montana seeks an Overpayment Recovery Specialist to review and recover funds from complex, non-routine refunds. You will collaborate with internal teams and providers to allocate refunds, perform adjustments, and ensure compliance with policies.

This full-time role requires proven medical claims processing experience, strong attention to detail, and effective communication skills for outbound provider outreach and customer inquiries.

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 calls, including provider outreach.
• 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 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 teams, 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 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.
• Perform claim adjustments and rework calculations across all dollar amounts.
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures.
• 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

Attention to detail

Education

Associate degree

Tools

DG system

Job description

CVS Health in Montana seeks an Overpayment Recovery Specialist to review and recover funds from complex, non-routine refunds. You will collaborate with internal teams and providers to allocate refunds, perform adjustments, and ensure compliance with policies.

This full-time role requires proven medical claims processing experience, strong attention to detail, and effective communication skills for outbound provider outreach and customer inquiries.