AI-Driven Medicare Policy & Reimbursement Analyst

Jobicy; United States; Remote; USD 107,000 - 130,000; Full time

Benefits offered by this job

Stock Purchase Plan (ESPP)

Office setup reimbursement

Monthly cell phone & internet stipend

Remote-first culture

Paid parental leave

Job summary

Clover Health is seeking an AI-forward Business Analyst, Clinical & Reimbursement Policy to bridge regulatory requirements with automated policy execution. You will own the lifecycle of clinical and reimbursement policies, translating NCDs and LCDs into actionable logic and coordinating with external vendors for policy oversight.

You will lead AI-driven monitoring initiatives, leverage LLMs to stay ahead of industry trends, and ensure policy intent aligns with technical adjudication across

Qualifications

• 5+ years of experience in healthcare claims, configuration, or reimbursement policy, with emphasis on Medicare Advantage.
• Experience interpreting and operationalizing CMS guidelines (NCDs/LCDs).
• Experience managing vendor relationships at a strategic level.

Responsibilities

• Own the development and maintenance of clinical and reimbursement policies aligned with CMS regulations.
• Interpret and operationalize Medicare guidelines (NCDs, LCDs) into actionable logic.
• Oversee external vendor performance and drive data-driven reviews.
• Lead AI initiatives to automate monitoring of reimbursement policies using LLMs.
• Collaborate with Configuration and Data Science teams to synchronize policy intent with adjudication.

Skills

AI-forward

Medicare expertise

Vendor management

Policy governance

CMS regulations

NCDs LCDs

LLMs

Tools

Claims engines

Adjudication systems

Job description

Clover Health is seeking an AI-forward Business Analyst, Clinical & Reimbursement Policy to bridge regulatory requirements with automated policy execution. You will own the lifecycle of clinical and reimbursement policies, translating NCDs and LCDs into actionable logic and coordinating with external vendors for policy oversight.

You will lead AI-driven monitoring initiatives, leverage LLMs to stay ahead of industry trends, and ensure policy intent aligns with technical adjudication across