Associate, Payment Integrity

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.

The Payment Integrity team is a motivated, collaborative team sitting at the intersection of Clover’s provider relationship operations, data infrastructure, and software. The Payment Integrity team ensures that Clover pays claims in a fair, transparent, compliant, and medically justified manner. Come join us as we discover new opportunities to improve the financial health of Clover while strengthening provider relationships and building a better healthcare system.

As an Associate for Payment Integrity Vendor Management at Clover Health, you will be responsible for the management of cost containment vendors. You will be responsible for ensuring adherence to service-level agreements and compliance with Clover’s internal policies and procedures, while maximizing the return on investment driven by each vendor.

As an Associate, Payment Integrity, you will:

• Oversee day-to-day operations of Clover’s cost containment vendors. Serve as point-of-contact between external vendors and various operations teams within Clover.
• Monitor, evaluate, and report on overpayment inventory to ensure for findings accuracy, adherence to SLA’s, and compliance with Clover P&P’s. Review and approve vendor overpayment identifications prior to pursuit.
• Identify, research, and resolve complex and escalated claim payment issues originating from vendor findings.
• Manage workflows and processing of vendor identifications from quality review through recovery, with a focus on developing efficiencies for future growth.

Success in this role looks like:

• By the end of your initial 90-day period, you have seamlessly integrated into the Payment Integrity Team and started to establish strong relationships with key internal and external vendor partners. You have developed a foundational knowledge of work streams in which you are responsible for, and have a strong understanding of audit concepts that derive overpayment recovery inventories.
• By 6 months, you will be working autonomously to execute on day-to-day functions that drive quality and consistent flow of post-pay inventories. You have demonstrated a deep understanding of workflows that support the audit life cycle and maintain compliance with aging requirements.
• Future success in this role will be measured by accuracy, the ability to meet predetermined monthly targets, and contributions towards ongoing process improvements.

You should get in touch if:

• You hold a BA/BS degree or equivalent experience along with 2+ years of experience in the healthcare industry, with deep exposure to Payment Integrity and Medicare Advantage.
• You have 2+ years of experience billing, coding, processing, and/or auditing claims along with knowledge of correct coding guidelines (CPT, HCPCS, DRG, and ICD 9/10) and reimbursement methodologies (FFS/professional, APC, DRG, etc.). Coding certification through AAPC or AHIMA a plus.
• You are technologically savvy with strong computer skills in Access, Excel, Visio, PowerPoint and basic knowledge of SQL. Knowledge of statistical methods used in the evaluation of healthcare claims data preferred.  Google Sheets and Docs are a plus.
• You have a working knowledge of CMS rules and regulations.
• You have experience with payment integrity vendor business partners.
• You are available during Eastern/Central US business hours; candidates in these time zones preferred.

Benefits Overview:

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!