Remote Medical Claims Auditor | AI‑Driven Prepay Audits

Clover Health; United States; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Equity

Bonus

401k

Flexible time off

Medical, dental, vision

Parental leave

Remote-first culture

Job summary

Clover Health is hiring a CPC with 3+ years of coding and auditing experience to review claims for billing and coding issues in collaboration with SIU and Clinical teams. The role leverages AI tools to flag anomalous patterns and support prepayment audits.

The ideal candidate has strong CMS/CCI knowledge and Medicare coding expertise. This is a remote-first opportunity with competitive compensation and benefits from a fast-growing, mission-driven company.

Qualifications

• 3+ years of coding and auditing experience.
• Strong knowledge of CMS regulations, CCI, and Medicare coding.
• Experience working with SIU and clinical teams is a plus.

Responsibilities

• Review claims for billing and coding issues with SIU and Clinical teams.
• Use AI tools to identify anomalous billing patterns and support prepayment audits.

Skills

Claims auditing

CMS regulations knowledge

Medicare coding

CPC certification

Education

CPC Certification

Job description

Clover Health is hiring a CPC with 3+ years of coding and auditing experience to review claims for billing and coding issues in collaboration with SIU and Clinical teams. The role leverages AI tools to flag anomalous patterns and support prepayment audits.

The ideal candidate has strong CMS/CCI knowledge and Medicare coding expertise. This is a remote-first opportunity with competitive compensation and benefits from a fast-growing, mission-driven company.