Payment Integrity Analyst

Job description

The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider network, claims, and technology teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spending. As a Payment Integrity Analyst, you will be responsible for identifying, researching, developing, and maintaining a portfolio of medical cost savings opportunities. This position will leverage strong technical knowledge to build complex SQL queries to size and ultimately deploy high-value individual cost-savings concepts as well as assist with the identification of these audit opportunities. In addition, the Senior Associate will be responsible for the creation of monthly, quarterly, and annual Payment Integrity financial reports as well as ad-hoc reports to support operations. As a Payment Integrity Analyst, you will: - Identify, develop, and deploy a portfolio of cost-saving concepts and initiatives that drive specific and measurable results for Clover. - Translate individual concepts into SQL code that can be deployed in an automated fashion against Clover's pending and/or paid claims...