Clover Health · 8 hours ago
Medical Claims Auditor
United States
Full-time
Remote
Mid Level
$90K/yr - $110K/yr
3+ years expClover Health is a fast-growing startup focused on reinventing health insurance through data and human empathy. As a Medical Claims Auditor in the Special Investigation Unit, you will ensure compliance and effectiveness in the fight against healthcare fraud, waste, and abuse by reviewing claims and identifying audit opportunities.
Health CareHealth InsuranceHospitalMedical
Responsibilities
Partner with Clinical, Claims, and SIU peers to review claims for billing and coding related issues on a retrospective basis that currently drive inaccurate payments to providers or indicate FWA
Identify control opportunities to mitigate FWA
Identify possible audit opportunities
Support annual FWA audit goals
Support provider conversations around FWA audit findings
Manage overall audit workload to ensure timely and accurate audit results
Work closely with senior team members and management on targeted projects and initiatives
Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams
Qualification
Required
3+ years of coding and auditing experience
Strong knowledge of the National Rules of Correct Codification defined by CMS in the Manual of CCI and the tables of CCI
Experience working in a technology environment including claims systems, workflow management tools, Microsoft Office or Google Suite
Prior experience working in health insurance
Preferred
Experience with CMS regulations
Certified Professional Coder (CPC) or other coding certification
Experience with Medicare Advantage
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
Initiatives such as 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