Investigator, SIU

Clover Health

6d•$83,000 - $125,000•Remote

About The Position

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 Special Investigation Unit (SIU) is a collaborative team at the crossroads of Compliance, Payment Integrity, and Data Infrastructure, focused on detecting and investigating healthcare fraud, waste, and abuse (FWA). As an Investigator, you'll help scale Clover’s FWA audit program, ensuring regulatory compliance and quality assurance. You’ll develop and execute effective audit strategies to identify and report suspected FWA, while growing your policy and operational expertise in a fast-paced, tech-driven healthcare environment.

Requirements

You have 3+ years of experience in the healthcare FWA space.
You have experience identifying operations and process improvement efforts.
You have an understanding of compliance & payer requirements including Medicare regulations.
You have knowledge on fraud statutes and regulations and preferably hold certifications like CFE, AHFI, or similar.

Responsibilities

Implement an effective audit strategy to investigate known or suspected instances of FWA.
Support complex provider conversations around FWA audit findings.
Prepare response letters to deliver information to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).
Manage overall audit workload to ensure timely and accurate audit results.
Act as a FWA subject matter expert.
Collaborate to identify possible audit opportunities.
Build strong working relationships with both regulatory and law enforcement agencies.
Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.
Support annual FWA goals

Benefits

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.
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!