Overpayment Recovery Specialist (Medical Claims)

CVS Health; Wisconsin; On-site; USD 26,000 - 54,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Wellness programs

Other resources

Job summary

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate refunds, handle complex inquiries, and ensure compliance with policies. You will work with internal teams and external partners to secure recoveries and manage overpayment inventory.

The role involves outbound provider outreach, detailed analysis, and adherence to regulatory guidelines. It offers full-time hours and a comprehensive benefits package, with opportunities to impact billing accuracy and customer care.

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.
• Coordinate 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.
• Monitor overpayment work inventory and follow up to achieve recovery goals.
• Coordinate with key business functions on escalated overpayments to drive resolution.
• Analyze alternatives 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 junior team members.
• Handle customer service inquiries and issues.

Skills

Medical claims processing

Claims adjustments/rework

Outbound provider outreach

Customer service

Attention to detail

Multitasking

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate refunds, handle complex inquiries, and ensure compliance with policies. You will work with internal teams and external partners to secure recoveries and manage overpayment inventory.

The role involves outbound provider outreach, detailed analysis, and adherence to regulatory guidelines. It offers full-time hours and a comprehensive benefits package, with opportunities to impact billing accuracy and customer care.