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Operations Associate, Payment Integrity

1 week, 2 days ago
United States
Full-time
Junior
Operations Specialist
Operations
SFTP SQL
Apply Now
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised
View All Jobs 47

Description

  • Facilitate high-volume claim reprocessing cycles by aggregating, merging, reviewing, and validating claim adjustment batches.
  • Perform backend reconciliations to audit the accuracy of batch-reprocessed claims and ensure expected adjustments are captured.
  • Manage recovery posting and resolution by reconciling claims data and tracking official recovery recognition in audit software.
  • Administer audit letter workflows, including data extraction, secure file transfers, proofing member and provider letters, and uploading files to external systems and vendors.
  • Monitor and maintain audit software status to validate audit population integrity and resolve aging audits.
  • Collaborate with Claims Adjustment, Provider Services, and other internal stakeholders to resolve escalated payment issues and support recovery outcomes.
  • Develop and refine process documentation, workflows, and standard operating procedures to improve operational efficiency.
  • Support coordination between internal and external stakeholders across payment integrity work streams.

Requirements

  • 3+ years of experience working with large datasets in a high-volume environment.
  • Experience with reconciliations, data validation, and data transfers.
  • Strong attention to detail and a track record of identifying discrepancies and ensuring data accuracy.
  • Experience supporting financial audits within a healthcare setting, with exposure to claims data, payments, or audit workflows.
  • Proficiency in Excel or Google Sheets, including pivots, lookups, and cleaning large data volumes.
  • Ability to learn new systems, tools, and workflows quickly.
  • Bonus: experience with SQL or healthcare audit/analytics tools.
  • Comfort managing large datasets and taking on technical challenges.
  • A results-oriented mindset with interest in process optimization and automation.

Benefits

  • Competitive base salary of $63,000–$83,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan (ESPP).
  • Performance-based bonus program and 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Flexible time off, plus No-Meeting Fridays and monthly company holidays.
  • Remote-first work culture.
  • Access to mental health resources.
  • Learning programs, mentorship, professional development funding, and regular performance feedback.
  • Reimbursement for office setup expenses and a monthly cell phone and internet stipend.
  • Paid parental leave for all new parents.

Interested in this position?

Apply directly on the company website

Apply Now

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