Operations Associate, Payment Integrity
C
Clover HealthHealthcare
Remote - USAFull-TimeMiddle
Salary63000 - 83000 USD per year
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Job Details
- Experience
- 3+ years
- Required Skills
- SQLMicrosoft ExcelGoogle Sheets
Requirements
- 3+ years of experience working with large datasets, including reconciliations, data validation, and transfers in a high-volume environment
- Technically savvy and comfortable learning new systems, tools, and workflows quickly
- Strong attention to detail and a track record of catching discrepancies and ensuring data accuracy
- Supported financial audits within a healthcare setting, with exposure to claims data, payments, or audit workflows
- Confident in Excel or Google Sheet, specifically in processing and cleaning extensive data volumes (e.g., pivots, lookups)
Responsibilities
- Execute Claim Reprocessing Cycles: Facilitate the aggregation of high-volume claim batches for reprocessing.
- Perform Reprocessing Reconciliations: Facilitate backend controls to audit the accuracy of batch-reprocessed claims.
- Manage Recovery Posting & Resolution: Reconcile claims data to determine the accuracy and completeness of reprocessed claims.
- Optimize Audit Letter Workflows: Manage the end-to-end administration of audit communications.
- Maintain Status Reconciliation: Perform ongoing monitoring and maintenance of audit software to validate the integrity of the audit population.
- Collaborate Across Functions: Partner with the Claims Adjustment Team, Provider Services, and key internal stakeholders to resolve escalated payment issues.
- Drive Process Excellence: Develop and refine process documentation, workflows, and standard operating procedures (SOPs).
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