Team Lead - Adjustments and Recovery

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

Responsible for researching complex medical claim rework, overpayment refund, and recovery tas k s and solutioning encountered system issues; maintaining and managing automated refund and recovery programs/processes; providing support to leadership to meet business KPI's; conducting user acceptance testing (UAT). Partner with vendors, reconcile and problem-solve inquiries for payment integrity programs. Collaborate with key stakeholders to maintain and meet business performances . Manage recovery work inventory; provide training on recovery tasks; mentor and be the subject matter expert (SME) to team members.

• Support leadership, assist in strategic planning and overall work completion to meet established KPI's for claim overpayment Recovery .
• Collaboratively develop training materials; perform training to new hires or internal cross-trainings.
• Facilitate meetings to staff and/or other departments; provide updates/clarifications for accurate completion of claim overpayment refund/recovery tasks.
• Mentor and provide guidance on posting of overpayment refunds and recovery to team members; review and direct resources to ensure accuracy.
• Distribute urgent/escalated work assignments daily to staff.
• Use analytical and statistical techniques and tools to plan and perform research and analysis of processes (e.g., outcomes performance guarantees, government regulations, and customer requirements, etc.) to recommend enhancements and workable solutions.
• In partnership with business owners, support the design and development of new processes.
• Participate in the development and validation of master or detail UAT test plans and strategies.
• Develop and design data collection capability (e.g., recovery, refund work inventory)
• Lead working sessions to develop recovery processes and/or resolve issues, including create enhancements and process efficiency.
• Support the creation of communication strategies and presentations for both internal and external customers to educate and address continuous improvement initiatives.
• Analyze and resolve complex overpayment recovery and refund scenarios with vendors and internal business functions , within established time frames.
• May, under supervision, develop quality assessment/measurement programs tailored to specific assignments.
• Analyze customer feedback and other measures.

• 2+ years medical claim rework/adjustment experience.
• 2+ years medical claims processing experience.
• Excellent verbal and written communication skills.
• Independent decision-making skill.
• Effective organizational and interpersonal skills.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.

• Experience working on project teams
• Experience conducting user acceptance testing (UAT)
• DG claims system experience
• Experience performing recovery tasks and/or processing overpayment refunds.

• Associate degree or equivalent experience.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.