Payment Integrity, Vendor Oversight Specialist 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 Vendor Oversight Specialist within our Payment Integrity team, you will play a critical role ensuring that Clover is able to continue to build and scale a compliant, efficient and profitable recovery program. You will work to build strong relationships with vendor partners, set expectations about performance and partner with cross-functional teams to implement new vendors. 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 relationship management and operational skills.

As a Payment Integrity, Vendor Oversight Specialist, you will:

Both manage the performance and maintenance of multiple vendor relationships and create reports based on the performance and health of vendor relationships.

Work cross-functionally to implement new vendor partnerships while maintaining compliance with HIPPA.

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

Digest complex concepts and regulations and communicate them effectively to different stakeholders.

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 a process person, and you can set up scalable operations that keep us moving without any one person becoming a bottleneck.

You forge new relationships easily and have a savvy mind to understand other parties' true concerns and motivations.

You can easily weigh a variety of considerations, both qualitative and quantitative, and are able to organize and communicate those considerations to help us make intelligent decisions.

You are a strong communicator. You have 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 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 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 3+ years experience managing external vendor relationships.

You have experience with HIPPA compliant data exchange protocols.

You have experience working with claims or payment integrity - preferred but not required.

You have prior experience working in health insurance; Medicare Advantage is a plus.

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.