Operations Associate, Payment Integrity

Clover is reinventing health insurance by working to keep people healthier.

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.

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 an Operations Associate for Payment Integrity at Clover Health, you will play a key role in facilitating the underlying processes that support various cost containment work streams. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and be responsible for facilitating recoveries on a growing membership base while supporting coordination between internal and external stakeholders.

As an Operations Associate, Payment Integrity, you will:

• Execute Claim Reprocessing Cycles: Facilitate the aggregation of high-volume claim batches for reprocessing. Utilize advanced data management and spreadsheeting techniques to merge, review, and validate cycles of claim adjustments, ensuring precision prior to final submission.
• Perform Reprocessing Reconciliations: Facilitate backend controls to audit the accuracy of batch-reprocessed claims. Conduct comprehensive reconciliations to ensure that all expected adjustments are captured and processed without discrepancy.
• Manage Recovery Posting & Resolution: Reconcile claims data to determine the accuracy and completeness of reprocessed claims. Oversee the audit software environment to control resolution tracking and ensure official recovery recognition aligns with Payment Integrity standards.
• Optimize Audit Letter Workflows: Manage the end-to-end administration of audit communications, including the extraction of data, secure SFTP transfers, rigorous proofing of member/provider letters, and the successful upload of files to external systems and vendors.
• Maintain Status Reconciliation: Perform ongoing monitoring and maintenance of audit software to validate the integrity of the audit population. Proactively research and resolve aging audits to minimize inventory lag and ensure timely recovery.
• Collaborate Across Functions: Partner with the Claims Adjustment Team, Provider Services, and key internal stakeholders to resolve escalated payment issues and optimize recovery outcomes while preserving strong provider partnerships.
• Drive Process Excellence: Develop and refine process documentation, workflows, and standard operating procedures (SOPs) to strengthen team capabilities and maximize operational efficiency.

Success in this role looks like:

• By the end of your initial 90-day period, you have seamlessly integrated into the Payment Integrity Team and established strong relationships with key internal partners. You have developed a foundational knowledge of the audit software and the end-to-end recovery workflows, successfully executing your first cycles of claim batch aggregation and audit letter distributions.
• By 6 months, you will be independently managing the recovery posting process and performing complex reprocessing reconciliations. You will be recognized as a subject matter expert in status reconciliation, effectively reducing the volume of aging audits and ensuring the accuracy of all recovery data reported by the department.
• Future success in this role requires strong data management and spreadsheet skills combined with innovative thinking and a results-centric approach to drive tangible outcomes. You should be comfortable managing large datasets, confidently taking on technical challenges, and identifying opportunities for process optimization and automation.

You should get in touch if:

• You have 3+ years of experience working with large datasets, including reconciliations, data validation, and transfers in a high-volume environment.
• You’re technically savvy and comfortable learning new systems, tools, and workflows quickly.
• You have a strong attention to detail and a track record of catching discrepancies and ensuring data accuracy.
• You’ve supported financial audits within a healthcare setting, with exposure to claims data, payments, or audit workflows.
• You’re confident in Excel or Google Sheet, specifically in processing and cleaning extensive data volumes to ensure accuracy, completeness, and integrity. (e.g., pivots, lookups).
• Bonus: You have experience with SQL or healthcare audit/analytics tools.

Benefits Overview:

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. 
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!

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, perspectives, opinions, 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.

#LI-REMOTE

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.