Operations Associate, Payment Integrity

Clover Health

16h•Remote

About The Position

Clover is reinventing health insurance by working to keep people healthier. 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 Operations Associate for Payment Integrity at Clover Health, you will play a key role in facilitating the underlying processes that support various cost containment work streams. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and be responsible for facilitating recoveries on a growing membership base while supporting coordination between internal and external stakeholders.

Requirements

You have 3+ years of experience working with large datasets, including reconciliations, data validation, and transfers in a high-volume environment.
You’re technically savvy and comfortable learning new systems, tools, and workflows quickly.
You have a strong attention to detail and a track record of catching discrepancies and ensuring data accuracy.
You’ve supported financial audits within a healthcare setting, with exposure to claims data, payments, or audit workflows.
You’re confident in Excel or Google Sheet, specifically in processing and cleaning extensive data volumes to ensure accuracy, completeness, and integrity. (e.g., pivots, lookups).

Nice To Haves

You have experience with SQL or healthcare audit/analytics tools.

Responsibilities

Execute Claim Reprocessing Cycles: Facilitate the aggregation of high-volume claim batches for reprocessing. Utilize advanced data management and spreadsheeting techniques to merge, review, and validate cycles of claim adjustments, ensuring precision prior to final submission.
Perform Reprocessing Reconciliations: Facilitate backend controls to audit the accuracy of batch-reprocessed claims. Conduct comprehensive reconciliations to ensure that all expected adjustments are captured and processed without discrepancy.
Manage Recovery Posting & Resolution: Reconcile claims data to determine the accuracy and completeness of reprocessed claims. Oversee the audit software environment to control resolution tracking and ensure official recovery recognition aligns with Payment Integrity standards.
Optimize Audit Letter Workflows: Manage the end-to-end administration of audit communications, including the extraction of data, secure SFTP transfers, rigorous proofing of member/provider letters, and the successful upload of files to external systems and vendors.
Maintain Status Reconciliation: Perform ongoing monitoring and maintenance of audit software to validate the integrity of the audit population. Proactively research and resolve aging audits to minimize inventory lag and ensure timely recovery.
Collaborate Across Functions: Partner with the Claims Adjustment Team, Provider Services, and key internal stakeholders to resolve escalated payment issues and optimize recovery outcomes while preserving strong provider partnerships.
Drive Process Excellence: Develop and refine process documentation, workflows, and standard operating procedures (SOPs) to strengthen team capabilities and maximize operational efficiency.

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!