Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.
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.
Own and maintain client-facing reporting that measures cost savings, outcomes, and performance of prior authorization programs across specialty areas.
Build, maintain, and QC actuarial models and methodology behind that reporting, keeping them ready to scale to new clients and lines of business.
Analyze and interpret authorization and claims data to identify trends, key drivers, and opportunities to improve customer value, quantifying the dollar and utilization effect of each.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. Backed by leading investors and named to the Inc. 5000 list, the company fosters a supportive, growth-oriented culture with diverse and inclusive teams.
Lead the MA Plan Command Center, setting direction and operating standards for governance, initiative portfolio management, and executive reporting.
Own enterprise performance monitoring frameworks, dashboards, and KPIs to identify risks and guide leadership decisions.
Integrate financial, actuarial, and operational insights into clear recommendations for executive leadership, leveraging AI-enabled analysis.
We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. Our team is composed of passionate, mission-driven individuals with diverse expertise, working together to solve healthcare challenges.