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Clover Health
Medical Claims Auditor
Remote · USA · Full time · Mid level
$92.3k–$120k / year
About the role
The Medical Claims Auditor ensures Clover builds and scales a compliant, effective fraud, waste, and abuse audit program focused on Medicare coding policies. The role involves reviewing claims, leveraging AI tools, and collaborating with teams to prevent inaccurate payments and disrupt fraud.
What you’ll do
• Review claims for billing and coding issues prepayment and retrospectively. • Use AI tools to identify anomalous billing patterns. • Collaborate with Data Science to validate AI-flagged claims. • Identify control opportunities to mitigate fraud, waste, and abuse. • Support provider conversations on audit findings.
What you’ll bring
• 3+ years coding and auditing experience. • Certified Professional Coder (CPC) required. • Strong knowledge of CMS National Rules of Correct Codification. • Experience with claims systems and workflow tools. • Work authorization for USA.
Life at Clover Health
Offers competitive salary, equity, bonuses, 401k matching, comprehensive health coverage, mental health resources, remote-first culture, and professional development.
About Clover Health
Clover Health reinvents health insurance by combining data and empathy to provide personalized care and improve members' health outcomes.