Remote AI-Driven Policy Analyst, Clinical & Reimbursement

Clover Health; Northern (KY); Hybrid; USD 107,000 - 130,000; Full time

Benefits offered by this job

Remote-first culture

ESPP offering discounted equity

Job summary

Clover Health is hiring a Business Analyst, Clinical & Reimbursement Policy for a remote role in the USA. You will own the lifecycle of clinical and reimbursement policies, translating Medicare guidance into automated, precise policy logic and overseeing vendor performance to ensure accuracy in the claims environment.

Ideal candidates have 5+ years in healthcare claims or reimbursement policy, experience with NCDs/LCDs, and a strong AI-forward approach using tools like Claude, Gemini, or ChatGPT

Qualifications

• 5+ years of experience in healthcare claims, configuration, or reimbursement policy (Medicare Advantage)
• Strong AI-forward mindset and familiarity with LLMs (Claude, Gemini, ChatGPT) a plus
• Experience interpreting NCDs and LCDs and translating guidelines into policy logic

Responsibilities

• Own the development and maintenance of clinical and reimbursement policies aligned with CMS regulations.
• Interpret and operationalize Medicare guidelines (NCDs, LCDs) into actionable policy logic.
• Oversee external vendors for policy monitoring and accuracy with data-driven reviews.
• Lead AI initiatives to automate monitoring of reimbursement policies using advanced tools.
• Collaborate with Configuration and Data Science teams to align policy intent with adjudication systems.
• Bridge Clinical, Claims, and Compliance teams to ensure unified payment excellence.

Job description

Clover Health is hiring a Business Analyst, Clinical & Reimbursement Policy for a remote role in the USA. You will own the lifecycle of clinical and reimbursement policies, translating Medicare guidance into automated, precise policy logic and overseeing vendor performance to ensure accuracy in the claims environment.

Ideal candidates have 5+ years in healthcare claims or reimbursement policy, experience with NCDs/LCDs, and a strong AI-forward approach using tools like Claude, Gemini, or ChatGPT