Business Analyst, Clinical & Reimbursement Policy

Clover Health

Business Analyst in Clinical & Reimbursement Policy at Clover Health focusing on Medicare guidelines and AI-driven policy monitoring. Ensuring compliance and collaboration with vendors for enhanced oversight.

Posted 5/15/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $107,000 - $130,000 per yearWebsite

About the role

Key responsibilities & impact

Own the accountability for the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines.
Serve as the primary oversight for external vendor performance regarding policy monitoring and accuracy. Hold partners to world-class standards through data-driven performance reviews and collaborative workflow design.
Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies. Utilize advanced LLMs (such as Claude, Gemini, and ChatGPT) to conduct regular deep research on ongoing industry trends.
Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy intent is perfectly synchronized with technical adjudication.
Act as the strategic bridge between Clinical, Claims, and Compliance teams to ensure a unified vision of payment excellence.

Requirements

What you’ll need

You have 5+ years of experience in healthcare claims, configuration, or reimbursement policy, with a heavy emphasis on Medicare Advantage.
You are extremely AI-forward and are passionate about how emerging technologies and LLMs (Claude, Gemini, ChatGPT, etc.) can be applied to drive operational precision in research and monitoring.
You are a Medicare expert with a proven track record of interpreting and operationalizing complex clinical policies, NCDs, and LCDs.
You have experience managing vendor relationships at a strategic level, ensuring external partners meet rigorous performance standards.
Preferred qualifications include coding certifications such as CPC, CCS, COC, or CIC.
You are a data-focused professional who builds strategy based on dashboards and trend analysis.
You are familiar with enterprise claims engines and understand how these systems interact to drive adjudication accuracy.

Benefits

Comp & perks

Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities, reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, enabling collaboration with global teams, paid parental leave for all new parents, and much more!

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Medicare guidelinesNCDsLCDsreimbursement policydata analysisAI implementationLLMsoperationalizing clinical policiesvendor managementtrend analysis

Soft Skills

strategic thinkingcollaborationcommunicationperformance managementaccountabilityleadershipdata-driven decision makingproblem-solvinginterpersonal skillsworkflow design

Certifications

CPCCCSCOCCIC