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Recovery Analyst

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Work at Home

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Category:
Finance

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Contract Type:
Not provided

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Salary:

18.50 - 42.35 USD / Hour
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Job 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 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.

Job Responsibility:

  • 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
  • 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

Nice to have:

  • Independent decision-making skills
  • Effective communications, organizational, and interpersonal skills
  • Familiarity with posting of refunds
  • Familiarity with overpayments recovery
  • DG system claims processing experience
What we offer:
  • Medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • bonus, commission or short-term incentive program

Additional Information:

Job Posted:
April 24, 2026

Expiration:
April 24, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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