Payment Integrity Analyst

1 hour, 34 minutes ago
Full-time
Senior
Data Science and Analytics
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

Description

  • Identify, develop, and deploy cost-saving concepts and initiatives that drive measurable results.
  • Build complex SQL code to translate concepts into automated audits against pending and paid claims data.
  • Support and develop medical record review and administrative hold concepts and edits.
  • Lead cross-functional discussions with billing experts, clinical staff, and operations managers to improve claims workflows.
  • Train team members to create SQL code for minor reporting and quick analysis.
  • Support daily operational tasks including triaging Salesforce tickets, creating audit letters, and processing reimbursements.
  • Influence senior leadership to adopt new policies, procedures, concepts, and initiatives that improve payment accuracy and cost containment.
  • Serve as a subject matter expert on claims, enrollment, and clinical data and partner with data and engineering teams on issues.
  • Generate monthly, quarterly, and annual financial reports, along with ad-hoc operational reports.

Requirements

  • 2+ years of experience with expert-level SQL proficiency and healthcare claims analysis.
  • 5+ years of experience in the data and analytics space.
  • 2+ years of experience working in healthcare data, preferably Medicare-related.
  • BA/BS degree or equivalent experience.
  • Experience with GitHub branching, merging, pull requests, and move-to-production protocols.
  • Working knowledge of CMS rules and regulations.
  • Experience working with complex processes in a technical environment and synthesizing data for senior leadership.
  • Expertise using AI-assisted workflows to accelerate query writing and data cleaning.
  • Strong ability to translate claims data into actionable insights using Excel, Visio/Lucid, and Google Suite.

Benefits

  • Competitive base salary of $90,000 to $120,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan with discounted shares.
  • Performance-based bonus program and 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Generous flexible time-off policy and monthly company holidays.
  • Remote-first culture with flexibility to work from anywhere.
  • Mental health resources and No-Meeting Fridays.
  • Learning programs, mentorship, professional development funding, and regular performance feedback.
  • Reimbursement for office setup expenses, monthly cell phone and internet stipend, and paid parental leave for all new parents.

Interested in this position?

Apply directly on the company website

Apply Now

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