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About the Role:
- The Payment Integrity team ensures claims are paid accurately and consistently.
- You will investigate potential discrepancies and translate data into defensible findings.
What You'll Do:
- Investigate payment inaccuracies using Medicare Advantage adjudication knowledge.
- Run SQL queries and review claims data to distinguish exceptions from supported issues.
- Document findings clearly for reproducibility and downstream review.
Who You Are:
- Experienced in payment integrity, reimbursement analysis, or claims audit.
- Proficient in SQL and Excel with strong investigative judgment.
Benefits:
- Comprehensive medical, dental, and vision coverage.
- Flexible time-off, remote-first culture, and professional development support.
Clover Health
Clover Health provides healthcare plans for seniors, using data and technology to improve care and lower costs. The company is a remote-first, mission-driven organization focused on diversity and inclusion.