[Remote] Operations Specialist, Payment Integrity

Note: The job is a remote job and is open to candidates in USA. Clover Health is reinventing health insurance by focusing on keeping people healthier. The Operations Specialist for Payment Integrity will support multiple cost containment work streams, ensuring accurate payment of medical claims and recovering overpayments while collaborating with various teams to enhance operational efficiency.

Responsibilities

• 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)

Skills

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

Benefits

• Competitive base salary and equity opportunities
• Performance-based bonus program
• 401k matching
• Regular compensation reviews to recognize and reward exceptional contributions
• Comprehensive medical, dental, and vision coverage
• No-Meeting Fridays
• Monthly company holidays
• Access to mental health resources
• Generous flexible time-off policy
• Learning programs
• Mentorship
• Professional development funding
• 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

Company Overview