Payment Integrity Analyst

At Clover Health , we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most. Clover’s Payment Integrity team is responsible for ensuring claims are paid accurately, consistently, and in accordance with applicable requirements. We’re looking for a Payment Integrity Analyst who brings strong Medicare Advantage claims and reimbursement knowledge, investigative judgment, and the ability to translate claims data into defensible findings. In this role, you’ll investigate potential payment inaccuracies, evaluate claims populations identified through SQL analysis, and determine whether the evidence supports a payment issue or a correctly adjudicated outcome. You’ll research applicable requirements, work through claim histories and exceptions, and help turn validated findings into actionable r…