Clover Health · 1 month ago
Business Analyst, Appeals & Grievances
United States
Full-time
Remote
Entry, Mid Level
$69K/yr - $84K/yr
2+ years expClover Health is reinventing health insurance by providing high-quality, affordable healthcare plans to America’s seniors. As a Business Analyst for Grievances, Appeals & Disputes, you will ensure compliance and operational efficiency while transforming data into actionable insights to enhance member experience and quality outcomes.
Health CareHealth InsuranceHospitalMedical
Responsibilities
Deliver timely daily and weekly operational reports to track case volumes, timeliness, and performance against KPIs
Validate A&G case inventory for accuracy, completeness, and compliance with CMS requirements
Analyze operational data to identify trends, root causes, and opportunities for process improvement
Collaborate with Operations, Compliance, and IT to implement workflow enhancements and regulatory updates
Support the development and integration of CMS and organizational guidance into operational systems
Partner with the Quality and STARS teams to monitor decision-making metrics and drive performance improvements
Prepare for audits by ensuring reporting and documentation are accurate, comprehensive, and audit-ready
Provide data-driven insights to cross-functional partners and governance committees to enhance member experience
Qualification
Required
2+ years of experience in healthcare operations, business analysis, or compliance (A&G/Medicare Advantage experience strongly preferred)
Highly skilled in data analysis and problem-solving, with the ability to spot trends and validate large data sets
Experience producing operational dashboards and reports using Excel and BI tools (SQL, Tableau, Power BI a plus)
Familiar with CMS regulations and Complaint Tracking Module (CTM) processes
Excel at communicating insights clearly and collaborating across Operations, Compliance, and IT teams
Thrive in a fully remote environment and are based in the U.S. Central or Eastern time zones (working primarily on ET hours)
Benefits
Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
Remote-first culture, enabling collaboration with global teams
Paid parental leave for all new parents
And much more!
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
Fierce Healthcare
2026-01-19
2026-01-16
Company data provided by crunchbase