Recovery Savings Analyst- Meritain

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.

Recover and allocate overpaid dollars, including complex, non-routine refunds. Manage overpayment inventory, partner with third-party vendors and internal business units, research and respond to recovery inquiries, and conduct provider outreach (including outbound calls) to secure recoveries. Ensure all work aligns with compliance requirements and company policies and procedures.

• →Review, collect, and resolve overpayment recovery items, including conflicting, missing, or inaccurate information, via 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 written and phone correspondence with members, providers, and other insurers
• →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
• →Use analysis and evaluation of 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 customer service inquiries and issues assigned

• 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

• Independent decision-making skills
• Effective communication, organizational, and interpersonal skills
• Familiarity with refund posting
• Familiarity with overpayment recovery
• DG system claims processing experience

• Associate degree or equivalent experience
  

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.