Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.
United States of America
Remote - US
Clover is reinventing health insurance by working to keep people healthier.
The Provider Solutions team was created to ensure that Clover is successfully managing our contracted providers' most complex operational needs. Clover knows our members and contracted provider partners are best served when we can help collaboratively resolve through the normal course of business. The Provider Solutions team will serve as a conduit between Clover and our providers to diffuse and resolve payor-provider exacerbations. The Provider Solutions team will work with Network and with operational leaders across Clover, including, but not limited to claims, payment integrity (PI) and utilization management (UM) to optimize Clover's provider relationships.
As a Provider Solutions Associate, you will play a critical role in strengthening provider relationships through resolution of complicated 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 executive within provider organizations as well as within Clover with an 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: Network, Provider Data, Claims, Configuration, Payment Integrity and Finance.
- Develop procedures and lead projects to improve overall provider experience
- Research, resolve, and respond to provider-related escalations received through Salesforce and Email
- 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 INN status and new Clover policies
- Assist in identifying opportunities for process and technology improvements to drive down provider abrasion
- Escalate issues to Provider Solutions Director/Manager.
- Perform other duties as assigned or directed.
You will love this job if:
- You are a great communicator and able to communicate across different teams and upward to management.
- You are a habitual strategic prioritizer, and able to identify where and when to focus your energy.
- You are a problem solver and like getting your hands dirty with the details of a gnarly problem.
- You have an insatiable curiosity which feeds an appetite to learn and teach.
You should get in touch if:
- You have 2+ years experience working in provider network, provider relations, insurance operations, or payment integrity.
- You are a Certified Professional Coder and have a working understanding of healthcare topics, such as claims processing, prior authorizations, medical billing and coding, payment integrity and physician reimbursement models.
- You have an understanding of compliance and payer requirements including Medicare regulations.
- You have the ability to interpret the contents of a medical record, an understanding of CPT and ICD-CM coding and knowledge of reimbursement practices for physician and facility services.
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.