Operations Associate Payment Integrity

Role Overview

As an Operations Associate – Payment Integrity at Clover Health, you will support the operational processes that underpin cost containment work streams. You’ll help ensure Clover’s medical claims are paid accurately, and you’ll assist with recoveries while coordinating across internal and external stakeholders.

Responsibilities

• Execute Claim Reprocessing Cycles
  • Aggregate high-volume claim batches for reprocessing.
  • Use advanced data management and spreadsheeting to merge, review, and validate claim adjustment cycles with high precision before submission.
• Perform Reprocessing Reconciliations
  • Support backend controls to audit the accuracy of batch reprocessed claims.
  • Conduct reconciliations to ensure expected adjustments are correctly reflected.
• Facilitate Recoveries & Stakeholder Coordination
  • Support recovery activities on a growing membership base.
  • Coordinate between internal and external stakeholders to drive outcomes.

Requirements

• Experience facilitating or supporting high-volume claims processing and related operational workflows.
• Strong skills in data management and spreadsheet-based analysis for validation and reconciliation work.
• Ability to execute reprocessing cycles with precision and attention to compliance/accuracy standards.

Nice to Haves

• Familiarity with payment integrity, claims reprocessing, reconciliation controls, and cost containment processes in healthcare/insurance operations.