Job description
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:
- Facilitate the end-to-end processes of time sensitive vendor solutions deployed to ensure accurate billing and appropriate provider reimbursement.
- Monitor, analyze, and report on claims inventory to ensure adherence to CMS timelines and Clover’s policies.
- Effectively communicate with vendor liaisons to maintain all operational aspects programs in scope.
- Support the broader Payment Integrity recovery process by preparing and managing high volumes of claims data.
- Validate the accuracy of claim adjustment requests through comprehensive reconciliations and continuous monitoring.
- Research and resolve escalated payment issues identified as the result of Payment Integrity initiatives.
- Collaborate with Payment Integrity Team Members, Claims Adjustment Team, Provider Services, and key stakeholders to optimize outcomes while preserving strong provider partnerships.
- Develop and refine process documentation, workflows, and standard operating procedures to strengthen team capabilities.
- Support subject matter experts in improving team efficiency and maximizing return on investment through process optimization.
Success in this role looks like:
- By the end of your initial 90-day period, you have seamlessly integrated into the Payment Integrity Team and started to establish strong relationships with key internal partners and vendor liaisons. You have developed a foundational knowledge of workflows that support various Payment Integrity initiatives.
- By 6 months, you will be supporting Payment Integrity’s end-to-end operations including monitoring and reporting on inventories, and managing the recoupment process to facilitate the complete audit life cycle.
- Future success in this role requires strong data management skills combined with innovative thinking and a results-centric approach to drive tangible outcomes. Confidently taking on challenges and looking for new ways of working, seeking efficiencies, and identifying opportunities for process improvements.
You should get in touch if:
- You have a Bachelor’s degree or equivalent professional experience with 2+ years in healthcare, including exposure to health plan payment integrity practices.
- You have experience in healthcare and can easily demonstrate proficiency with Excel or Google Sheets.
- You have knowledge of CMS rules and regulations combined with hands-on claims processing, project management, or auditing experience.
- You have SQL and statistical analysis capabilities, medical coding certifications (AAPC/AHIMA), healthcare analytics platform experience, and knowledge of value-based care models (is a plus!)
Benefits Overview:
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
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.
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 $72,000 to $100,000. 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.
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