Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience. At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, and prioritize safety and quality in everything they do.
Job Summary Recover and allocate overpaid dollars, including complex, non-routine refunds. You'll manage overpayment inventory, partner with third-party vendors and internal business units, research and respond to recovery inquiries, and conduct provider outreach to secure recoveries.
Key Responsibilities
- Review, collect, and resolve overpayment recovery items with limited supervision
- Partner with internal business units, vendors, and liaisons to recover funds and allocate refunds
- Administer overpayment recovery policies and procedures
- Manage overpayment work inventory and monitor progress to achieve recovery goals
- Coordinate with key business functions on escalated overpayments
- Use analysis and evaluation to solve complex recovery issues
- Track inventory, productivity, and recovery results using reporting
- Perform claim adjustments and rework calculations
- Apply medical necessity guidelines and determine coverage
- Process complex provider refunds and returned checks
- Review and interpret provider contract language to validate overpayments
- Deliver recovery training to less experienced team members as needed
- Handle customer service inquiries and issues
Requirements
- 3+ years of medical claims processing experience
- 2+ years of medical claims adjustments and/or rework experience
- 2+ years of experience working in a fast-paced, deadline-driven environment
- Experience conducting outbound calls and handling customer service inquiries
- Ability to interpret and apply guidelines related to eligibility, coverage, and benefits
- Demonstrated ability to manage multiple assignments with accuracy and attention to detail
Preferred Qualifications
- Independent decision-making skills
- Effective communication, organizational, and interpersonal skills
- Familiarity with refund posting and overpayment recovery
- DG system claims processing experience
Education
- Associate degree or equivalent experience
Pay and Benefits The typical pay range for this role is $18.50 - $38.82 per hour. This position is eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs.