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The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, and Data Infrastructure. The SIU ensures that Clover monitors, identifies, and investigates instances of healthcare fraud, waste and abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA!
As a Medical Claims Auditor within our Special Investigations Unit, you will play a critical role in ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your policy and operational skills. A successful Medical Claims Auditor will have a broad coding knowledge base, including but not limited to: DME, Outpatient, ASC and Physician correct coding. This position will focus specifically on Medicare coding policies.
As a Medical Claims Auditor, you will:
Success in this role looks like:
You should get in touch if:
Benefits Overview:
Additional Perks:
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
#LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
Ready to apply?
Apply to Clover Health
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Clover is reinventing health insurance by working to keep people healthier.
At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.
The Payment Integrity team is a motivated, collaborative team sitting at the intersection of Clover's provider relationship operations, data infrastructure, and software. The Payment Integrity team ensures that Clover pays claims in a fair, transparent, compliant, and medically justified manner. Come join us as we discover new opportunities to improve the financial health of Clover while strengthening provider relationships and building a better healthcare system.
As an Operations Associate for Payment Integrity at Clover Health, you will play a key role in facilitating the underlying processes that support various cost containment work streams. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and be responsible for facilitating recoveries on a growing membership base while supporting coordination between internal and external stakeholders.
As an Operations Associate, Payment Integrity, you will:
Success in this role looks like:
You should get in touch if:
Benefits Overview:
Additional Perks:
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
#LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
Ready to apply?
Apply to Clover Health
Share this job
The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider Network, Claims, and Technology teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend.
As Senior Clinical Payment Integrity Auditor at Clover Health, you will ensure the health of our prepay clinical review program by playing a key role in program development and expansion, cross-functional cooperation, and ensuring quality assurance standards and regulatory policy are reflected in clinical claims processing practices. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and recovering overpayments when they are identified.
As a Senior Clinical Payment Integrity Auditor, you will:
Success in this role looks like:
You should get in touch if:
Benefits Overview:
Additional Perks:
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
#LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
Ready to apply?
Apply to Clover Health
Share this job
The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider network, claims, and technology teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spending.
As a Payment Integrity Senior Analyst, you will be responsible for identifying, researching, developing, and maintaining a portfolio of medical cost savings opportunities. This position will leverage strong technical knowledge to build complex SQL queries to size and ultimately deploy high-value individual cost-savings concepts as well as assist with the identification of these audit opportunities. In addition, the Senior Analyst will be responsible for the creation of monthly, quarterly, and annual Payment Integrity financial reports as well as ad-hoc reports to support operations.
As a Payment Integrity Senior Analyst, you will:
Success in this role looks like:
You should get in touch if:
Benefits Overview:
Additional Perks:
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
#LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
Ready to apply?
Apply to Clover Health
Share this job
Clover is reinventing health insurance by working to keep people healthier. We are a Medicare Advantage plan working to develop deeper insights to drive better outcomes for our members through our integrated technology platform. We rely on our abilities to integrate standard health plan data with clinical information from provider health information systems. The Medical Management team is at the center of this work, ensuring our members receive high-quality, appropriate care.
We are looking for an extremely detail-oriented Medical Director with a strong background in Payment Integrity (PI) and Utilization Management (UM). This is a full-time, hands-on role for someone who thrives "in the weeds" and enjoys the challenge of deep medical record review. You will be responsible for using your discerning clinical judgment to ensure medical necessity, appropriate utilization, and payment accuracy. This position reports to the Chief Medical Officer, Medicare Advantage (CMO).
As a Medical Director, Payment Integrity & Utilization Management, you will:
Success in this role looks like:
You should get in touch if:
Benefits Overview:
Additional Perks:
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
#LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
A reasonable estimate of the base salary range for this role is $270,000 to $300,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
#LI-Remote
Ready to apply?
Apply to Clover Health
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