Recovery Savings Analyst- Meritain
About The Position
The Recovery Savings Analyst recovers and allocates overpaid dollars, including complex, non-routine refunds. The role manages overpayment inventory, partners with third-party vendors and internal business units, researches and responds to recovery inquiries, and conducts provider outreach—including outbound calls—to secure recoveries. All work must align with compliance requirements and company policies and procedures. The analyst reviews and resolves overpayment recovery items, handles claim adjustments and rework calculations, processes complex provider refunds and returned checks, and uses reporting to track inventory, productivity, and recovery results. The position also applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, supports claim adjudication, and may provide recovery training to less experienced team members.
Requirements
- At least 3 years of medical claims processing experience.
- At least 2 years of medical claims adjustments and/or rework experience.
- At least 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 by 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 equivalent experience.
Nice To Haves
- Independent decision-making skills.
- Effective communication, organizational, and interpersonal skills.
- Familiarity with refund posting.
- Familiarity with overpayment recovery.
- DG system claims processing experience.
Responsibilities
- Review, collect, and resolve overpayment recovery items, including conflicting, missing, or inaccurate information, through phone and written correspondence with limited supervision.
- Partner with internal business units, vendors, and liaisons to recover funds and fully allocate refunds.
- Administer overpayment recovery policies and procedures, including correspondence with members, providers, and other insurers by phone and in writing.
- 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.
- Analyze and evaluate alternatives 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 to support claim adjudication.
- Process complex provider refunds and returned checks.
- Review and interpret provider contract language to validate overpayments and support allocation of refund checks.
- Deliver recovery training for less experienced team members as needed.
- Handle assigned customer service inquiries and issues.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligibility for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
