Provider Services Associate
Clover Health, Jersey City, NJ or Nashville, TN or Remote
Clover is a Medicare Plan done differently.
Clover is reinventing health insurance by working to keep people healthier.
The Provider Services team is a new function at Clover 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 issues through the normal course of business. The Provider Services team will serve as a conduit between Clover and our providers to diffuse and resolve payor-provider exacerbations. The Provider Services team will work with network and operational leaders across Clover, including, but not limited to the heads of the Claims, Payment Integrity (PI) and Utilization Management (UM) teams to optimize Clover's provider relationships.
As a Provider Services Associate, you will play a critical role in strengthening provider relationships by resolving 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 executives within provider organizations and within Clover. They will have the 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 Services Associate, you will:
- Leverage your understanding of provider and payer operations to resolve complex issues arising between those organizations and deescalate those situations accordingly.
- Work with all aspects of Clover's operations to ensure complex issues are tracked and resolved to resolution, including resolution of the ultimate root cause.
- Ability to interpret and implement provider contract terms
- Drive a more collaborative and constructive relationship between Clover's operational teams and our strategic provider partners.
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 experience working in provider network, provider relations, insurance operations, or payment integrity.
- You have a working understanding of healthcare topics, such as claims processing, prior authorizations, medical billing and coding 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.
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.
Clover Health welcomes qualified candidates with disabilities and will provide accommodations during the interview process as needed. If you require accommodations, please email [email protected] with the details of your requested accommodation. Requests are reviewed by a member of the recruiting team. Requests will have no bearing on the candidate evaluation process or hiring decisions.
About Clover Health
Clover Health is a data driven health insurance startup driving to improve the overall state of healthcare in America. We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road. Unlike other health insurance companies also embracing preventive health, Clover’s Medicare is built on technology from the ground-up. Integrating our systems with doctors, clinicians, and nurse practitioners, Clover’s data team helps healthcare professionals in the field intervene directly into patients’ wellness to help them avoid acute health episodes. If you’re a passionate person and interested in changing healthcare for the better, then Clover may just be the place for you.