At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care.
As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives.
We are passionate.
We are looking for an AI-forward Business Analyst, Clinical & Reimbursement Policy to serve as the strategic bridge between regulatory.
In this high-impact role, you will be responsible for the end-to-end lifecycle of Clover’s clinical and reimbursement policies, ensuring they are accurately interpreted, regularly updated, and seamlessly integrated into our claims environment.
You will act as a primary Subject Matter Expert (SME), translating complex Medicare guidelines—including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)—into actionable logic.
You will also play a critical role in vendor management, partnering with external vendors to enhance policy oversight.
Your mission is to accelerate Clover's transition toward a high-precision payment ecosystem where monitoring and research are highly automated, ensuring clinical and reimbursement policies are seamlessly and accurately operationalized.
As a Business Analyst, Clinical & Reimbursement Policy, you will: Policy Lifecycle & Compliance: Own the accountability for the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
Medicare Regulatory SME: Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines.
Strategic Vendor Management: Serve as the primary oversight for external vendor performance regarding policy monitoring and accuracy.
Hold partners to world-class standards through data-driven.