Strategic Overpayment Recovery Analyst

CVS Health; Ohio; Hybrid; USD 25.000 - 53.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Retirement savings

Paid time off

Wellness programs

Zusammenfassung

CVS Health is seeking an Overpayment Recovery Specialist for its Ohio operation. You will recover and allocate overpaid dollars, handle non-routine refunds, and coordinate with vendors and internal teams.

This role emphasizes compliance, accuracy, and timely recoveries. Ideal candidates have 3+ years in medical claims processing, strong attention to detail, and the ability to manage multiple tasks in a fast-paced environment.

Qualifikationen

• 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.

Aufgaben

• Review, collect, and resolve overpayment recovery items, including conflicting, missing, or inaccurate information, via phone and written correspondence with limited supervision
• Partner with internal business units, vendors, and liaisons to recover funds and fully allocate refunds
• Administer overpayment recovery policies and procedures, including written and phone correspondence 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 and evaluation of 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 using claims processing expertise
• Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures to support claim adjudication
• Process complex provider refunds and returned checks
• Review and interpret provider contract language to validate overpayments and support allocation of refund checks
• Deliver recovery training for less experienced team members as needed
• Handle customer service inquiries and issues assigned

Kenntnisse

Medical claims processing

Claims adjustments and rework

Fast-paced environment

Outbound provider outreach

Customer service

Guidelines interpretation

Ausbildung

Associate degree or equivalent experience

Tools

DG system claims processing

Jobbeschreibung

CVS Health is seeking an Overpayment Recovery Specialist for its Ohio operation. You will recover and allocate overpaid dollars, handle non-routine refunds, and coordinate with vendors and internal teams.

This role emphasizes compliance, accuracy, and timely recoveries. Ideal candidates have 3+ years in medical claims processing, strong attention to detail, and the ability to manage multiple tasks in a fast-paced environment.