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Business Analyst, Clinical & Reimbursement Policy
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Clover Health·USA·17 авг.

Business Analyst, Clinical & Reimbursement Policy

8 917 – 10 833 $
≈ 772,9 тыс.–939 тыс. ₽
🌍 УдалённоSeniorПолная занятость🌐 Глобал
8 917 – 10 833 $≈ 772,9 тыс.–939 тыс. ₽
Платят на 36% выше медианы грейда.
Нажмите на сигнал, чтобы увидеть, на чём он основан

Наша компания

We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most. We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare. From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility. #LI-REMOTE Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc. A reasonable estimate of the base salary range for this role is: $107,000—$130,000 USD

Наши требования

You have 5+ years of experience in healthcare claims, configuration, or reimbursement policy, with a heavy emphasis on Medicare Advantage
You are extremely AI-forward and are passionate about how emerging technologies and LLMs (Claude, Gemini, ChatGPT, etc.) can be applied to drive operational precision in research and monitoring
You are a Medicare expert with a proven track record of interpreting and operationalizing complex clinical policies, NCDs, and LCDs
You have experience managing vendor relationships at a strategic level, ensuring external partners meet rigorous performance standards
Preferred qualifications include coding certifications such as CPC, CCS, COC, or CIC
You are a data-focused professional who builds strategy based on dashboards and trend analysis
You are familiar with enterprise claims engines and understand how these systems interact to drive adjudication accuracy

Мы предлагаем

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!

Дополнительно

By the end of your initial 90-day period: You will have established a recurring review framework and a comprehensive project plan for Clover's clinical and reimbursement policy library to ensure baseline quality and strict adherence to clinical guidelines
By 6 months: You will have ensured that all existing clinical and reimbursement policies are current and up to date, reflecting the latest regulatory requirements. You will also have implemented an AI-forward oversight framework that utilizes advanced research tools and early-detection monitoring to enhance accuracy within our adjudication systems. You will be actively leveraging AI tools like Claude, Gemini, and ChatGPT to perform deep-dive research on industry trends and regulatory updates
Continued success: You will lead the evolution of Clover’s policy management into a proactive strategic powerhouse. By championing automated monitoring and data-driven research, you will ensure Clover’s payment ecosystem achieves market-leading precision and technological sophistication

Технологии и навыки

analyst
Clover Health
Clover Health
USA

ГрейдSenior
ЗанятостьПолная занятость
РегионСША
ФорматУдалённо
ИсточникСкрыто
Опубликовано17 авг.
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