Operations Associate Payment Integrity

About the Role

Clover Health is reinventing health insurance by focusing on preventive care and leveraging data through the Clover Assistant to provide high-quality, affordable healthcare for seniors. The Payment Integrity team sits at the intersection of provider operations, data infrastructure, and software, ensuring claims are paid in a fair, transparent, and compliant manner.

As an Operations Associate, you will drive value by ensuring claim accuracy and facilitating recoveries through the following 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.
• Perform Reprocessing Reconciliations: Facilitate backend controls to audit the accuracy of batch-reprocessed claims and conduct comprehensive reconciliations to ensure all expected adjustments are processed correctly.

Required Skills