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CVS Health

Runs pharmacies, health plans and clinics

Recovery Savings Analyst

Claims AdjudicationUpdated on Nov 13
Full-timeRemote in USA

About the Job

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 accurately and with attention to detail.
  • Associate degree or equivalent 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 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.
  • 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.

Desired Qualifications

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

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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