Clover Health · 3 days ago
Operations Specialist, Payment Integrity
United States
Full-time
Remote
Entry Level
$68K/yr - $83K/yr
1+ years expClover Health is reinventing health insurance by focusing on keeping people healthier. The Operations Specialist for Payment Integrity will support multiple cost containment work streams, ensuring accurate payment of medical claims and recovering overpayments while collaborating with various teams to enhance operational efficiency.
Health CareHealth InsuranceHospitalMedical
Responsibilities
Manage key elements of the recovery workflows and communications to ensure Clover is accurately paying claims and partnering with Providers in an efficient, streamlined manner
Support the team with daily operational tasks such as triaging and responding to provider disputes and inquiries
Work cross-functionally across Payment Integrity, Claims, Provider Solutions, and other stakeholders to drive financial savings and maintain strong provider relationships
Incorporate cross-functional perspectives and business needs in solving complex problems
Support subject matter experts to improve team efficiency and maximize team ROI
Help shape the department by contributing to process documentation and training (e.g., meeting minutes, workflows and standing operating procedures)
Qualification
Required
1+ year of experience in healthcare, preferably in process improvement, operations, and/or analytics
Ability to execute on daily tasks and priorities, effectively communicating progress to leadership
Strong project management or administrative skills and can multi-task while being highly organized and thorough
Ability to regularly identify opportunities to implement efficient process/operational improvements
Working knowledge of Excel and able to produce basic reports when requested
Working understanding of healthcare topics, pertaining to Network, such as, physician reimbursement models, data sharing in provider partnerships, and PCP engagement
Benefits
Competitive base salary and equity opportunities
Performance-based bonus program
401k matching
Regular compensation reviews to recognize and reward exceptional contributions
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Access to mental health resources
Generous flexible time-off policy
Learning programs
Mentorship
Professional development funding
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
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