Senior Investigator

1 hour, 56 minutes ago
Full-time
Senior
Cybersecurity
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

  • Lead process improvements to increase the effectiveness and efficiency of SIU audit operations.
  • Identify control opportunities to mitigate fraud, waste, and abuse.
  • Identify and prioritize audit opportunities and implement an audit strategy for known or suspected FWA cases.
  • Support annual FWA audit goals and manage overall audit workload to ensure timely, accurate results.
  • Support complex provider conversations regarding audit findings.
  • Prepare response letters to providers within CMS regulatory timeframes.
  • Act as a subject matter expert on fraud, waste, and abuse investigations.
  • Mentor team members on audit strategies and investigation practices.
  • Build working relationships with regulatory and law enforcement agencies.
  • Communicate across multi-disciplinary teams to build trust and support collaboration.

Requirements

  • 5+ years of experience in healthcare fraud, waste, and abuse.
  • Experience identifying operational improvements and process improvement opportunities.
  • Understanding of compliance and payer requirements, including Medicare regulations.
  • Knowledge of fraud statutes and regulations.
  • Fraud Investigation Certification such as CFE or AHFI preferred but not required.
  • Ability to work autonomously on cases and provider reviews after onboarding.
  • Experience navigating case flow and multiple internal systems is expected.
  • Background in quality assurance or audit practices is relevant to the role.

Benefits

  • Competitive base salary of $104,000 to $127,000.
  • Equity opportunities, including an Employee Stock Purchase Plan (ESPP).
  • Performance-based bonus program and 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Remote-first culture with flexibility to work from any location.
  • Generous flexible time-off policy, including no-meeting Fridays and monthly company holidays.
  • 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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