Clover Health
Business Analyst, Clinical & Reimbursement Policy
DERemotePosted Today$107,000 – $130,000
Full TimeSeniorRemoteDE
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Job Description
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 ai
Key Highlights
- Policy Lifecycle & Compliance: Own the accountability for the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
- Medicare Regulatory SME: Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines.
- Strategic Vendor Management: Serve as the primary oversight for external vendor performance regarding policy monitoring and accuracy. Hold partners to world-class standards through data-driven performance reviews and collaborative workflow design.
- AI-Driven Evolution: Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies. Utilize advanced LLMs (such as Claude, Gemini, and ChatGPT) to conduct regular deep research on ongoing industry trends.
- System Integration: Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy intent is perfectly synchronized with technical adjudication.
About the Company
Clover Health
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Job Details
Employment Type
Full Time
Experience Level
Senior
Salary Range
$107,000 – $130,000
Location
DE
Work Mode
Remote
Posted
Today
Country
DE