Strategic Overpayment Recovery Specialist

CVS Health; Elm (PA); Vor Ort; USD 25.000 - 53.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Zusammenfassung

CVS Health is seeking a detail-oriented Recovery Specialist to handle overpayment recovery, refunds, and provider outreach. The role supports compliance and accuracy across complex claims processing and requires strong communication and problem-solving skills.

Anticipated weekly hours are 40 and the time type is Full time. The role offers benefits including medical, dental, vision coverage, and retirement options, with eligibility for CVS Health bonus programs.

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.
• Demonstrated ability to manage multiple assignments with a high degree of accuracy and attention to detail.

Aufgaben

• Review, collect, and resolve overpayment recovery items via phone and written correspondence with limited supervision.
• Partner with internal business units, vendors, and liaisons to recover funds and allocate refunds.
• Administer overpayment recovery policies and procedures, including communications 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 to solve complex, non-routine recovery issues.
• Use reporting to track inventory, productivity, and recovery results.
• Perform claim adjustments and rework across all dollar amounts using claims processing expertise.
• Apply medical necessity guidelines and verify eligibility to support claim adjudication.
• Process complex provider refunds and returned checks.
• Review provider contract language to validate overpayments and refund allocations.
• Deliver recovery training for less experienced team members.

Kenntnisse

Medical claims processing

Outbound calling

Customer service

Attention to detail

Multitasking

Ausbildung

Associate degree or equivalent experience

Tools

DG system claims processing

Jobbeschreibung

CVS Health is seeking a detail-oriented Recovery Specialist to handle overpayment recovery, refunds, and provider outreach. The role supports compliance and accuracy across complex claims processing and requires strong communication and problem-solving skills.

Anticipated weekly hours are 40 and the time type is Full time. The role offers benefits including medical, dental, vision coverage, and retirement options, with eligibility for CVS Health bonus programs.