At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care. As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives. We are passionate about making healthcare easier, more affordable, and more accessible for everyone.
We are looking for a highly analytical Senior Claims Researcher to join our Claims Excellence team. Reporting directly to the Director, Claim Payment Accuracy, you will be a key individual contributor responsible for executing the high-level technical audits and testing that ensure our claims are paid correctly the first time.
You are not just a claims processor; you are a "claims detective" who enjoys digging into complex data to find the "why" behind payment variances. In this role, you will perform deep-dive research and quality audits across our adjudication ecosystem, focusing on the intersection of provider contracts, benefit design, and system configuration. While you will not be ... Click Apply to read the full job description.