Clover Health

Director, Claim Payment Accuracy

Remote - USA · Director

Sponsorship not specified$150k-$195kDetected 20 days ago

LLMsResearchLeadershipCollaborationMentoring

About the role

As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives.
You are responsible for the quality oversight of claim payments and the ongoing maintenance of our clinical and reimbursement policies, ensuring that pricing, benefit rules, and contract terms result in flawless adjudication.
You will monitor the output of our systems and vendor partnerships to identify and mitigate leakage, ensuring that policies and contracts are seamlessly and accurately operationalized.

You will independently utilize advanced LLMs (such as Claude, Gemini, and ChatGPT ) to analyze oversight trends and develop data-driven criteria for judgmental sampling and targeted audits.
Serve as the lead for global payment accuracy oversight regarding our external BPaaS partner.
While Senior Managers and Directors in Config and Claims maintain direct operational relationships for their respective areas, you will hold the vendor to world-class standards through global accuracy reviews and data-driven performance monitoring.

Ensure that all findings are fed into a continuous improvement loop to enhance systemic accuracy.

Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
Paid parental leave for all new parents
About Clover: 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.
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.
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.
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.
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.

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.

This listing is sourced directly from Clover Health's careers page and normalized into a canonical job model.