Provider Solutions Associate

Title: Provider Solutions Associate

Location: Remote – USA

Clover is reinventing health insurance by working to keep people healthier.
The Provider Solutions team ensures that Clover is successfully managing our contracted providers’ most complex operational needs. The Provider Solutions team will serve as a conduit between Clover and our providers to diffuse and resolve critical payor-provider escalations. The Provider Solutions team will work with operational leaders across Clover, including, but not limited to Provider Data, Claims, Configuration, Payment Integrity, Customer Experience, Network, and Finance to optimize Clover’s provider relationships.

As a Provider Solutions Associate, you will play a vital role in strengthening provider relationships through resolution and education of complex provider issues. We are looking for a candidate with experience in health plan operations and a thorough understanding of the provider/payer dynamic and claims processing. Additionally, the ideal candidate will be comfortable interacting with administrators and executives within provider organizations as well as within Clover. The candidate should have a strong ability to synthesize issues, create a plan for resolution, and effectively communicate to all parties.

Come be at the heart of the action!

As a Provider Solutions Associate, you will:

• Be the subject matter specialist on all the Clover Health Operational area processes including: Contracting, Payment Integrity Audits, Member Grievances, Claims Configuration, and Processing.
• Lead projects to improve the overall provider experience.
• Become the designated representative for high priority providers and lead external calls on a monthly cadence and/or as needed.
• Research, resolve, and respond to provider-related escalations received internally and externally.
• Work cross-functionally with internal teams to research and resolve standard provider escalation issues including but not limited to claims, contract, provider data/directory, configuration, payment integrity and payment issues.
• Outreach to provider groups as needed to educate providers on network status and new Clover policies, initiatives, and best practices.
• Assist in identifying opportunities for process and technology improvements to drive down provider abrasion.
• Escalate issues to The Provider Solutions Management team when appropriate.
• Manage and/or support other projects and activities as assigned.

You will love this job if:

• You want to make an impact. You thrive off of helping others and want your work to make a difference in our providers’ lives, while also advocating for their needs.
• You are a team player. You know how to communicate effectively to build trust and lasting partnerships with many different types of people, teams, and stakeholders.
• You are a strategic prioritizer. You are able to identify where and when to focus your energy.
• You enjoy technology. You like learning about new programs and leveraging them to solve large issues.
• You have a critical and analytical mindset. You are able to break down complex information and/or comprehensive data into basic principles in order to make a thoughtful decision.

You should get in touch if:

• You have 3+ years experience in the health and medical insurance industry.
• You are proficient in Data Analytics and a multitude of programs including but not limited to: Microsoft Excel, Salesforce, JIRA, Mode, and Google Suites.
• You are a certified professional coder, preferred but not required.
• Understanding of healthcare topics such as: claims processing, prior authorizations, medical billing and coding, payment integrity and reimbursement practices for physician and facility services.
• Understanding of compliance and payer requirements, including but not limited to CMS Medicare regulations and guidelines.
• Understanding of interpreting medical records, CPT and ICD-CM coding guidelines.

#LI-Remote

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.