Operations Specialist, Payment Integrity

Clover is reinventing health insurance by working to keep people healthier. The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend.

As an Operations Specialist for Payment Integrity at Clover Health, you will play a key role in supporting multiple cost containment work streams across the Medicare Advantage and Direct Contracting lines of business. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and recovering overpayments when they are identified.

As an Operations Specialist, you will:

• Manage key elements of the recovery workflows and communications to ensure Clover is accurately paying claims and partnering with Providers in an efficient, streamlined manner.
• Support the team with daily operational tasks such as triaging and responding to provider disputes and inquiries.
• Work cross-functionally across Payment Integrity, Claims, Provider Solutions, and other stakeholders to drive financial savings and maintain strong provider relationships.
• Incorporate cross-functional perspectives and business needs in solving complex problems.
• Support subject matter experts to improve team efficiency and maximize team ROI.
• Help shape the department by contributing to process documentation and training (e.g., meeting minutes, workflows and standing operating procedures).

Success in this role looks like:

• By the end of your initial 90-day period, you will have demonstrated a strong understanding of our payment integrity workflow and are able to effectively navigate throughout the various Clover systems.
• By 6 months, you will be working autonomously to triage and prioritize incoming inquiries and communications.
• Continued success in this position anchors in on developing a deep understanding of the workflows that support our payment integrity review life cycle, while maintaining regulatory compliance standards.

You should get in touch if:

• You have 1+ year of experience in healthcare, preferably in process improvement, operations, and/or analytics.
• You are able to execute on daily tasks and priorities, effectively communicating progress to leadership. 
• You have strong project management or administrative skills and can multi-task while being highly organized and thorough. 
• You are able to regularly identify opportunities to implement efficient process/operational improvements.
• You have a working knowledge of Excel and are able to produce basic reports when requested.
• You have a working understanding of healthcare topics, pertaining to Network, such as, physician reimbursement models, data sharing in provider partnerships, and PCP engagement.

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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: