Medical Claims Auditor

Clover Health(11 days ago)

RemoteFull TimeMedior$90,000 - $110,000Special Investigations Unit (SIU)

About this role

The Medical Claims Auditor will join Clover’s Special Investigations Unit to support the development and scaling of a fraud, waste, and abuse (FWA) audit program. The role focuses on Medicare coding policies and retrospective claims review to ensure accurate payments and regulatory compliance within a healthcare technology environment.

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Required Skills

Medical Coding
Medicare Policies
Auditing
Claims Review
DME Coding
Outpatient Coding
Provider Communication
Regulatory Compliance
CMS Regulations
Workflow Tools

+1 more

Qualifications

Certified Professional Coder (CPC)

About Clover Health

cloverhealth.com

Clover Health is a Medicare Advantage provider offering HMO and PPO plans—many with $0 monthly premiums—bundling expanded benefits like dental, vision, and hearing. Headquartered in Jersey City, NJ, the company serves Medicare beneficiaries across multiple U.S. markets. Clover emphasizes a technology- and data-driven approach to care management, aiming to support providers, coordinate primary care, and improve member outcomes. It positions itself as a member-focused alternative designed to lower costs and simplify access to preventive and routine services.