Payment Integrity, Analytics Manager at Clover Health
San Francisco, CA, US
Clover is reinventing health insurance by working to keep people healthier.

The Payment Integrity team is a motivated, collaborative team sitting at the intersection of Clover's provider relationship operations, data infrastructure, and software. The Payment Integrity team ensures that Clover pays claims in a fair, transparent, compliant, and medically justified manner. Come join us as we discover new opportunities to improve the financial health of Clover, while strengthening provider relationships and building a better healthcare system.

As a Payment Integrity, Analytics Manager, you will play a critical role in ensuring that Clover has the subject matter expertise and analytical ability to identify, quantify and report on misappropriated paid claims. You will work cross-functionally to investigate, scale, document, audit, and report results. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your analytical and operational skills.

The core function of this role will use industry standards and CMS regulations to lead a team to identify, analyze and report claims that have been paid incorrectly due to claims edits, administrative billing errors, medical necessity, prior authorization and fraud waste and abuse.

As a Payment Integrity, Analytics Manager, you will:

Lead a team of analysts to identify misappropriated paid claims using industry standards and CMS regulation.

Be a people-oriented leader with a track record of mentoring others and building large-scale teams.

Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.

Digest complex concepts and communicate them effectively to different stakeholders.

Work closely with data scientists, engineers, and operational teams to create sustainable and scalable solutions.

Expand the scope of payments reviewed by using data analytics to find new opportunities.

Develop or expand performance metrics and funnels to assess the quality of our payments and their improvement over time.

Manage and expand Clover's data pipeline for payment integrity driving toward high data quality and automated reporting.

Document, implement and manage technical specifications, software vendor requirements, and our internal process.

Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration.

You will love this job if:

You are excited to lead and develop a growing function.

You have a critical and analytical mindset. You want to understand how all the pieces of a process fit together and quantify the contribution of each component.

You are a strong communicator. You have verbal and written communication skills that foster trust, knowledge sharing, and progress.

You are a team player. You enjoy partnering with others and want to work collaboratively to find new solutions.

You are detail-oriented. You pay attention to the small things while understanding how they fit into the larger picture.

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 are organized. You can prioritize your work, and weigh trade-offs on your own.

You are nimble and comfortable working in a constantly evolving environment.

You should get in touch if:

You have 6+ years of prior work experience in claims, payment integrity or revenue cycle accounting plus a proven background in analyzing data.

You have prior management and leadership experience.

You are excited about healthcare and eager to understand how it can be impacted by technology.

You have a history of meticulous work and strive for accuracy and efficiency.

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.