Recovery Savings Analyst

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Recover and allocate funds that have been overpaid, including intricate and non-routine refunds.

• Oversee the inventory of overpayments.

• Collaborate with external vendors and internal departments.

• Investigate and respond to inquiries related to recovery.

• Conduct outreach to providers, including making outbound calls, to ensure recoveries.

• Review, gather, and address overpayment recovery items through both phone and written communication.

• Work alongside internal teams, vendors, and liaisons to recover funds and allocate refunds appropriately.

• Implement overpayment recovery policies and procedures effectively.

• Track inventory progress and perform timely follow-ups to meet recovery objectives.

• Manage escalated overpayments to facilitate resolution and recovery.

• Assess alternatives to address complex, non-routine recovery challenges.

• Utilize reporting tools to monitor inventory, productivity, and recovery outcomes.

• Conduct claim adjustments and recalculate amounts across all dollar values.

• Apply medical necessity protocols, ascertain coverage, confirm eligibility, identify discrepancies, and implement cost containment strategies.

• Process complicated provider refunds and returned checks.

• Analyze and interpret provider contract terms to authenticate overpayments and assist in refund-check distribution.

• Provide recovery training for less experienced team members as required.

• Address assigned customer service inquiries and issues.

⛳️ Requirements

• Over 3 years of experience in medical claims processing.

• More than 2 years of experience in medical claims adjustments and/or rework.

• At least 2 years of experience in a fast-paced, deadline-oriented, high-volume environment.

• Experience in conducting outbound calls, including provider outreach.

• Proven experience in managing customer service inquiries via phone and/or written communication.

• Ability to understand and apply guidelines regarding eligibility, coverage, and benefits.

• Proven ability to handle multiple assignments with a high level of accuracy and attention to detail.

• Associate degree or equivalent experience is required.

• Familiarity with refund posting processes.

• Knowledge of overpayment recovery procedures.

• Experience with DG system claims processing.

• Strong independent decision-making skills.

• Excellent communication, organizational, and interpersonal skills.

🏝️ Benefits

• Participation in CVS Health bonus, commission, or short-term incentive programs.

• Comprehensive medical coverage.

• Dental insurance.

• Vision insurance.

• Paid time off.

• Options for retirement savings.

• Access to wellness programs.

• Additional resources that support physical, emotional, and financial well-being, subject to eligibility.