Strategic Overpayment Recovery Specialist

CVS Health; Kansas City (MO); Vor Ort; USD 25.000 - 53.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Zusammenfassung

CVS Health is seeking a detail-oriented overpayment recovery specialist to review and resolve complex refunds, work with internal teams and external vendors, and drive timely recoveries. You will handle provider outreach and escalation, ensuring adherence to compliance and policies.

The role requires 3+ years in medical claims processing, strong analytical skills, and a track record in fast-paced environments. This is a full-time position with CVS Health benefits and bonus eligibility.

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
• 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 and evaluation of alternatives to solve complex 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 refund allocation
• Deliver recovery training for less experienced team members
• Handle customer service inquiries and issues assigned

Kenntnisse

Medical claims processing

Claims adjustments/rework

Outbound calls

Customer service

Eligibility & benefits interpretation

Attention to detail

Ausbildung

Associate degree or equivalent experience

Tools

DG system claims processing

Jobbeschreibung

CVS Health is seeking a detail-oriented overpayment recovery specialist to review and resolve complex refunds, work with internal teams and external vendors, and drive timely recoveries. You will handle provider outreach and escalation, ensuring adherence to compliance and policies.

The role requires 3+ years in medical claims processing, strong analytical skills, and a track record in fast-paced environments. This is a full-time position with CVS Health benefits and bonus eligibility.