Payment Integrity Analyst (Fully Remote)

Clover Health; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

Clover Health is seeking an analytic specialist to investigate payment inaccuracies in Medicare Advantage claims and interpret reimbursement data to explain outcomes. You will review claim populations identified through SQL analyses, differentiate supported discrepancies from exceptions, and support downstream recovery and audits.

Documentation of findings will enable Compliance/Legal review and help prepare recurring audit materials, dashboards, and process improvements.

Responsibilities

• Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
• Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
• Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.

Job description

• Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
• Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
• Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.