Business Analyst, Clinical & Reimbursement Policy

Clover Health
United States
Workplace: RemoteFull timeUSD 107,000 - 130,000 annuallyFunction: Business OperationsExperience: 5+ yearsSkills: ["Communication","Collaboration","Problem-solving","Stakeholder management","Data-driven decision making"]

AI-forward Business Analyst bridging regulatory requirements and automated execution for Clover’s clinical and reimbursement policies. Own policy lifecycle, interpret Medicare guidelines (NCDs/LCDs), manage strategic vendor partnerships, and lead AI-driven monitoring and research to improve reimbursement accuracy within the claims ecosystem.

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Clover Health
Clover Health
2 months ago

Business Analyst, Clinical & Reimbursement Policy

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Source: Company careers pageValidated by: Fursa AI
Last checked: 5 hours agoStatus: Live

Job Summary

AI-forward Business Analyst bridging regulatory requirements and automated execution for Clover’s clinical and reimbursement policies. Own policy lifecycle, interpret Medicare guidelines (NCDs/LCDs), manage strategic vendor partnerships, and lead AI-driven monitoring and research to improve reimbursement accuracy within the claims ecosystem.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Business Operations

Key Responsibilities

  • •Policy lifecycle and compliance: Own the development and maintenance of clinical and reimbursement policies, ensuring alignment with CMS regulations.
  • •Medicare regulatory SME: Interpret and operationalize NCDs, LCDs, and general national coding guidelines for policy execution.
  • •Strategic vendor management: Oversee external vendor performance for policy monitoring and accuracy through data-driven reviews.
  • •AI-driven evolution: Lead AI initiatives to automate monitoring of reimbursement policies using advanced tools to perform regular research on industry trends.
  • •System integration: Collaborate with Configuration and Data Science teams to align policy intent with adjudication systems.”
  • •Cross-functional influence: Serve as the bridge between Clinical, Claims, and Compliance teams to ensure a unified vision of payment excellence.

Pay and Benefits

Salary: USD 107,000 - 130,000 annually
Equity and Bonus:Equity
Perks:Remote Work401kEquityEsppPaid Leave

Key Requirements

  • •5+ years of experience in healthcare claims, configuration, or reimbursement policy with emphasis on Medicare Advantage
  • •Extremely AI-forward and experienced with LLMs (Claude, Gemini, ChatGPT) for research and monitoring
  • •Medicare expert with proven track record interpreting and operationalizing complex clinical policies, NCDs, and LCDs
  • •Experience managing vendor relationships at a strategic level and ensuring partner performance
  • •Preferred coding certifications such as CPC, CCS, COC, or CIC
Experience:5+ yearsHealthcareMedicare AdvantageHealthcare claims
Skills:CommunicationCollaborationProblem-solvingStakeholder managementData-driven decision making
Certifications:CPCCCSCOCCIC
Languages:English
Tech Stack:ClaudeGeminiChatGPTLLMs

Company Brief

Clover Health
Clover Health is a technology-driven health insurance company offering Medicare Advantage plans that combine clinical care coordination, data analytics, and value-based care to improve outcomes and reduce costs for seniors.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Jersey City, United States
Founded: 2014
WebsiteLinkedIn