Remote opportunity at
Clover HealthBusiness Analyst, Clinical & Reimbursement Policy
Clover Health operates as a Medicare Advantage plan dedicated to enhancing member health outcomes through data-driven insights and technology, aiming to make healthcare simpler and more…
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About This Role
Clover Health operates as a Medicare Advantage plan dedicated to enhancing member health outcomes through data-driven insights and technology, aiming to make healthcare simpler and more affordable. The company seeks an AI-focused Business Analyst for Clinical and Reimbursement Policy to connect regulatory standards with automated processes. In this position, the professional manages the complete lifecycle of clinical and payment policies to ensure precise interpretation, regular updates, and correct integration within…
Job Description
Clover Health operates as a Medicare Advantage plan dedicated to enhancing member health outcomes through data-driven insights and technology, aiming to make healthcare simpler and more affordable. The company seeks an AI-focused Business Analyst for Clinical and Reimbursement Policy to connect regulatory standards with automated processes. In this position, the professional manages the complete lifecycle of clinical and payment policies to ensure precise interpretation, regular updates, and correct integration within the claims platform.
The person in this role acts as a primary subject matter expert for Medicare guidelines, translating National Coverage Determinations and Local Coverage Determinations into operational logic. Responsibilities include overseeing external vendor performance, introducing artificial intelligence initiatives to automate policy monitoring, and conducting deep research on industry trends using advanced large language models like ChatGPT, Gemini, and Claude. Collaboration occurs alongside Data Science, Configuration, Clinical, Claims, and Compliance groups to drive a unified payment strategy.
Ideal candidates bring extensive experience with Medicare Advantage and healthcare claims, pairing domain expertise with a passion for applying emerging technologies to operational research.
Responsibilities
- Manage the development and maintenance of clinical and reimbursement policies to ensure compliance with CMS regulations
- Interpret and operationalize Medicare guidelines, NCDs, LCDs, and general national coding rules
- Oversee external vendor performance concerning policy accuracy and monitoring through data-driven reviews
- Implement AI initiatives and utilize large language models to automate reimbursement policy monitoring and industry research
- Partner with Configuration and Data Science teams to align policy intent with technical adjudication
- Collaborate across Clinical, Claims, and Compliance divisions to support a unified payment strategy
Requirements
- Minimum of 5 years of professional experience in healthcare claims, reimbursement policy, or configuration
- Heavy emphasis and background working with Medicare Advantage
- Deep expertise in interpreting and operationalizing complex clinical policies, NCDs, and LCDs
- Experience managing vendor relationships at a strategic level to ensure compliance with performance standards
- Familiarity with enterprise claims engines and adjudication accuracy
Qualifications
- Coding certifications such as CPC, CCS, COC, or CIC
Core Skills
Benefits
- Competitive base salary and equity opportunities
- Performance-based bonus program and 401k matching
- Comprehensive medical, dental, and vision health coverage
- Flexible time-off policy, monthly company holidays, and No-Meeting Fridays
- Remote-first work culture
- Professional development funding, mentorship, and learning programs
- Employee Stock Purchase Plan offering discounted equity
- Reimbursement for office setup expenses
- Monthly cell phone and internet stipend
- Paid parental leave for all new parents
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this role is fully remote.
What is the salary range for this role?
The base salary range is estimated between USD 107,000 and 130,000 per year, with final pay depending on factors such as internal equity, market data, education, experience, and certifications.
What background is required to apply?
Applicants need five or more years of experience in healthcare claims, configuration, or reimbursement policy, with a strong focus on Medicare Advantage and expertise in interpreting NCDs and LCDs.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.