Cdr IIOps Account-OPS

Job DescriptionPosition SummaryThis position will be responsible for utilizing previous ACAS claims experience along with provided guidance to review and validate claims for overpayment. The ideal candidate will be able to work independently and with others to review claims tied to different overpayment projects in the Overpayment Tracking System, revalidate overpayment files, send claims to rework and verify accuracy when needed. The position requires strong verbal and written communication skills and a comprehensive understanding of ACAS claims overpayment scenarios. These skills will be utilized to meet plan sponsor Performance Guarantees. Responsibilities include: Review concepts and instructions provided by various constituents targeting overpaid claims Follow validation instructions provided by our constituents to properly review ACAS claims for overpayment Utilize ASD or GPS for claim review Utilize SCM where appropriate for claim review Review provider contracts in accordance with project concepts and validation instructions in order to identify overpaid claims Make collection calls to members and providers, coordinating with collection vendors and other internal collection teams. Refer claims in the ACAS overpayment system to ASD to rework claims after validating as overpaidPay RangeThe typical pay range for this role is:Minimum: 18.50Maximum: 33.65Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsRequired Qualifications 2 years' experience working with ASD or GPS, SCM, ECHS, and Claims X Ten Knowledge of ACAS claims systems Familiarity with e.PoliciesPreferred QualificationsPreferred Qualifications Previous experience with overpayments on the ACAS platform Project experience working with providers on overpayment issuesEducationBachelor degree in Accounting, Finance or a closely-related field, or an equivalent combination of formal education and recent and related experienceBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-10-04