Clover Health · 11 hours ago
Senior Investigator
United States
Full-time
Remote
Mid, Senior Level
$104K/yr - $127K/yr
5+ years expClover Health is a company focused on reinventing health insurance by combining data with human empathy to improve member health. The Senior Investigator will lead the development and execution of audit processes to identify and mitigate healthcare fraud, waste, and abuse, while ensuring compliance with regulatory standards.
Health CareHealth InsuranceHospitalMedical
Responsibilities
Lead development and execution of SIU process improvements to improve the effectiveness and efficiency of our SIU audit processes
Identify control opportunities to mitigate FWA
Identify possible audit opportunities
Implement an effective audit strategy to investigate known or suspected instances of FWA
Support annual FWA audit goals
Support complex provider conversations around FWA audit findings
Prepare response letters to deliver decisions to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS)
Manage overall audit workload to ensure timely and accurate audit results
Act as a FWA subject matter expert
Mentor other team members on audit strategies
Build strong working relationships with both regulatory and law enforcement agencies
Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams
Qualification
Required
5+ years of experience in the healthcare FWA space
Experience identifying operations and process improvement efforts
Understanding of compliance & payer requirements including Medicare regulations
Knowledge on fraud statutes and regulations
Preferred
Fraud Investigation Certification (CFE, AHFI, etc.) - preferred but not required
Benefits
Competitive base salary and equity opportunities
Performance-based bonus program
401k matching
Regular compensation reviews
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Access to mental health resources
Generous flexible time-off policy
Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
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