Strategic Overpayment Recovery Analyst

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate funds from overpayments, including complex refunds. You will partner with vendors and internal teams, conduct outreach, and ensure compliance with policies.

The role requires 3+ years of medical claims processing, strong attention to detail, and experience in a fast-paced environment. This full-time position offers a robust benefits package and bonus eligibility.

Qualifications

• 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.
• 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 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.
• 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 using claims processing expertise.
• 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.
• Deliver recovery training for less experienced team members as needed.
• Handle customer service inquiries and issues assigned.

Skills

Medical claims processing

Claims adjustments/rework

Outbound calls

Customer service

Eligibility interpretation

Attention to detail

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking an Overpayment Recovery Specialist to recover and allocate funds from overpayments, including complex refunds. You will partner with vendors and internal teams, conduct outreach, and ensure compliance with policies.

The role requires 3+ years of medical claims processing, strong attention to detail, and experience in a fast-paced environment. This full-time position offers a robust benefits package and bonus eligibility.