Clover is reinventing health insurance by working to keep people healthier.
The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend.
We are looking to hire Claims Processing Coordinators to perform a number of crucial tasks to support Clover's claims operations. In this position you will report to the Operations Lead and support the team's productivity and adherence to quality standards.
As a Claims Processing Coordinator, you will:
- Assist with claims disputes and reconciliations.
- Process claims and associated work queue inventories timely (e.g. medical record requests).
- Review claims outcomes and ensure appropriate routing for ancillary processing include medical record requests or provider and member escalations.
- Perform other duties and projects as assigned.
You will love this job if:
- You are technologically savvy and can quickly learn and use new software tools.
- You want to make an impact. You thrive off of helping others, and want your work to make a difference in our members' lives.
- You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.
- You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.
- You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.
- You are motivated to learn. There is no shortage of technical, clinical, and operational skills to learn at Clover.
- You are curious. You like to do research when you don't know an answer. You ask the hard questions and you don't sweep problems under the rug.
You should get in touch if:
- You have 1-2 years experience in supporting Medicare Advantage claims processing.
- You have knowledge of Medicare Advantage operations.
- You have previous experience with claims operating systems such as Facets, QNXT, Health Edge, or Amethyst.
- You have awareness of medical terminology, ICD-10, and CPT coding required.
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.
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.
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 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.
Clover Health welcomes qualified candidates with disabilities and will provide accommodations during the interview process as needed. If you require accommodations, please email with the details of your requested accommodation. Requests are reviewed by a member of the recruiting team. Requests will have no bearing on the candidate evaluation process or hiring decisions.