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Medical Claims Auditor
Clover Health · Remote - USA · Posted 9 days ago
Build and scale Clover's Medicare-focused FWA prepayment audit program, turning AI-flagged claims into systemic edits that stop improper payments before funds leave.
The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, and Data Infrastructure. The SIU ensures that Clover monitors, identifies, and investigates instances of healthcare fraud, waste and abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA!
As a Medical Claims Auditor within our Special Investigations Unit, you will play a critical role in ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your policy and operational skills. A successful Medical Claims Auditor will have a broad coding knowledge base, including but not limited to: DME, Outpatient, ASC and Physician correct coding. This position will focus specifically on Medicare coding policies.
As a Medical Claims Auditor, you will:
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This role centers on Medical Coding, Cms Regulations, Cci, and Claims Auditing. There are 57 open roles at Clover Health right now.
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