Operations Associate, Payment Integrity

Job Description

Join Clover Health as an Operations Associate, Payment Integrity, and play a crucial role in ensuring accurate and efficient claim processing. This position involves executing claim reprocessing cycles, performing reconciliations, managing recovery postings, and optimizing audit letter workflows. You will collaborate with cross-functional teams to resolve payment issues and drive process excellence. Responsibilities include: 1. Executing Claim Reprocessing Cycles: Facilitating the aggregation of high-volume claim batches for reprocessing. 2. Performing Reprocessing Reconciliations: Facilitating backend controls to audit the accuracy of batch-reprocessed claims. 3. Managing Recovery Posting & Resolution: Reconciling claims data to determine the accuracy and completeness of reprocessed claims. 4. Optimizing Audit Letter Workflows: Managing the end-to-end administration of audit communications. 5. Maintaining Status Reconciliation: Performing ongoing monitoring and maintenance of audit software to validate the integrity of the audit population. 6. Collaborating Across Functions: Partnering with the Claims Adjustment Team, Provider Services, and key internal stakeholders to resolve escalated payment issues. 7. Driving Process Excellence: Developing and refining process documentation, workflows, and standard operating procedures (SOPs) to strengthen team capabilities.

Qualifications

To succeed as an Operations Associate, Payment Integrity, you should have: 1. 3+ years of experience working with large datasets, including reconciliations, data validation, and transfers in a high-volume environment. 2. Technical savvy and comfort learning new systems, tools, and workflows quickly. 3. Strong attention to detail and a track record of catching discrepancies and ensuring data accuracy. 4. Experience supporting financial audits within a healthcare setting, with exposure to claims data, payments, or audit workflows. 5. Proficiency in Excel or Google Sheets, specifically in processing and cleaning extensive data volumes to ensure accuracy, completeness, and integrity. 6. Bonus: Experience with SQL or healthcare audit/analytics tools.

Benefits

Clover Health offers a comprehensive benefits package to support your well-being: - Financial Well-Being: Competitive base salary, equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews. - Physical Well-Being: Comprehensive medical, dental, and vision coverage. - Mental Well-Being: No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Remote-first culture. - Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews. - Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, paid parental leave, and more.