Remote opportunity at
Clover HealthPayment Integrity Analyst
Clover Health operates as a healthcare company focused on delivering affordable, straightforward healthcare plans tailored for older adults in the United States. Through preventive care strategies…
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About This Role
Clover Health operates as a healthcare company focused on delivering affordable, straightforward healthcare plans tailored for older adults in the United States. Through preventive care strategies and proprietary technology like the Clover Assistant, the organization connects physicians with comprehensive member health backgrounds to enhance care quality and manage expenses. The organization seeks a Payment Integrity Analyst to join its remote team on a full-time basis. This position involves investigating potential…
Job Description
Clover Health operates as a healthcare company focused on delivering affordable, straightforward healthcare plans tailored for older adults in the United States. Through preventive care strategies and proprietary technology like the Clover Assistant, the organization connects physicians with comprehensive member health backgrounds to enhance care quality and manage expenses.
The organization seeks a Payment Integrity Analyst to join its remote team on a full-time basis. This position involves investigating potential payment inaccuracies within Medicare Advantage claims, evaluating data populations using SQL, and translating findings into defensible recommendations. Professionals in this capacity will collaborate closely with a Senior Manager to research policy requirements, review complex claim histories, test competing explanations, and maintain transparent documentation.
Ideal candidates bring several years of direct Medicare Advantage reimbursement or claims audit experience, practical SQL proficiency, and strong Excel capabilities. The role suits detail-oriented investigators who can work independently, utilize approved artificial intelligence tools for research, and communicate technical findings clearly to various partners.
Responsibilities
- Investigate potential payment inaccuracies using Medicare Advantage adjudication and reimbursement knowledge
- Review claims populations identified via SQL analysis to separate valid exceptions from payment discrepancies
- Research relevant CMS, NCCI, and coding guidelines along with provider contracts and internal payment policies
- Analyze claim line details, payment components, adjustments, reversals, and historical records
- Independently execute and adapt SQL queries for specific dates, filters, and selections
- Gather evidence that could disprove suspected issues, such as correctly paid comparison claims
- Document validation steps, sources, exclusions, and financial impact for reproducible conclusions
- Utilize approved artificial intelligence tools to support research while verifying all outputs
- Audit automated tool outputs to eliminate false positives and refine precision rules
- Prepare findings to assist with recovery evaluations, operational resolutions, and compliance reviews
Requirements
- Three to five years of relevant experience in payment integrity, reimbursement analysis, claims audit, or related work
- Direct working experience with Medicare Advantage claims
- Practical knowledge of Medicare Advantage claims adjudication and reimbursement mechanics
- Ability to independently navigate large relational databases using SQL
- Strong Microsoft Excel skills for reviewing, filtering, comparing, and reconciling datasets
- Hands-on experience using AI tools for research or analytical tasks with sound verification judgment
- Clear written and verbal communication skills for technical and operational audiences
Qualifications
- Experience supporting overpayment investigations, payment corrections, or recovery reviews
- Experience testing claims payment rules or investigating configuration-related discrepancies
- Experience developing or maintaining recurring claims audits
- Relevant coding or reimbursement credentials
Core Skills
Benefits
- Competitive base salary and equity opportunities
- Performance-based bonus program and 401(k) matching
- Comprehensive medical, dental, and vision health coverage
- Flexible time-off policy alongside monthly company holidays and No-Meeting Fridays
- Remote-first work environment
- Employee Stock Purchase Plan offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone and internet stipend
- Paid parental leave for all new parents
- Learning programs, mentorship, and professional development funding
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
What is the location and remote status for the Payment Integrity Analyst role?
This position is fully remote as part of a remote-first culture.
What is the employment type for this position?
This is a full-time employment opportunity.
What salary range is offered for this role?
The reasonable estimate of the base salary range is $76,900 to $100,000 USD, determined by factors such as internal equity, market data, education, work experience, and certifications.
What are the core technical skill requirements?
Candidates must have practical SQL proficiency to navigate large relational databases, strong Excel skills for dataset reconciliation, and hands-on experience using approved AI tools for research and analysis.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.