Recovery Analyst

CVS Health

2d • $19 - $42

About The Position

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 passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Pursue the recovery and allocation of overpaid dollars, and non-routine and complex refunds. Manage, monitor, and work overpayment items. Partner with third-party vendors, research and respond to recovery inquiries. Make outbound calls to providers; track and conduct follow-ups to recover funds. Collaborate with key business functions on escalated overpayments to coordinate recovery efforts. May handle customer service inquiries and problems. Fundamental Components Review, collect, and resolve overpay or recovery conflicting, missing or inaccurate information via telephone or written correspondence with limited degree of supervision. Partner with internal customers/business units, third party vendors, and liaisons to recover and fully allocate refunds. Administer overpayment recovery policy and procedures, telephone and written correspondence to members, providers, and other insurers. Manage overpayment work; collaborate and conduct provider outreach to achieve business goals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Use a systematic approach in solving problems through analysis and evaluation of alternate solutions. Utilize available reports to track inventory and recovery results. May deliver recovery training programs for less experienced team members. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs medical claim re-work calculations. Process complex non-routine Provider Refunds and Returned Checks. Review and interprets medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Utilize all resource materials to manage job responsibilities.

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, 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
• Associate degree or High School Diploma and equivalent experience.

Nice To Haves

• Independent decision-making skills.
• Effective communications, organizational, and interpersonal skills.
• Familiarity with posting of refunds.
• Familiarity with overpayments recovery.
• DG system claims processing experience.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree