AI-Driven Clinical & Reimbursement Policy Analyst

Bazeta; United States; Remote; USD 120,000 - 170,000; Full time

Benefits offered by this job

Equity opportunities

Bonus program

401k matching

Medical, dental, vision

No-Meeting Fridays

Remote-first culture

Job summary

Clover Health is seeking an AI-forward Business Analyst to own the end-to-end lifecycle of clinical and reimbursement policies within a Medicare Advantage framework. You will translate NCDs and LCDs into precise policy logic and partner with external vendors to ensure accuracy in policy monitoring and execution.

The role emphasizes AI-driven research, cross-functional collaboration, and seamless integration with regulatory-compliant adjudication systems.

Qualifications

• 5+ years in healthcare claims, configuration, or reimbursement policy, with Medicare Advantage focus.
• Experience interpreting and operationalizing CMS guidelines (NCDs LCDs).
• Experience managing vendor relationships and performance.

Responsibilities

• Own development and maintenance of clinical and reimbursement policies aligned with CMS regulations.
• Translate Medicare guidelines into actionable logic for adjudication systems.
• Oversee external vendors for policy monitoring and accuracy with KPI-based reviews.
• Lead AI initiatives to automate monitoring of policies using tools like Claude, Gemini, and ChatGPT.
• Collaborate with Clinical, Claims, and Compliance teams to unify policy intent with adjudication logic.

Skills

AI awareness

Medicare knowledge

Data analysis

Cross-functional collaboration

Vendor management

Education

CPC

CCS

COC

CIC

Tools

Claude

Gemini

ChatGPT

Job description

Clover Health is seeking an AI-forward Business Analyst to own the end-to-end lifecycle of clinical and reimbursement policies within a Medicare Advantage framework. You will translate NCDs and LCDs into precise policy logic and partner with external vendors to ensure accuracy in policy monitoring and execution.

The role emphasizes AI-driven research, cross-functional collaboration, and seamless integration with regulatory-compliant adjudication systems.