Investigator Special Investigation Unit SIU
Investigator Special Investigation Unit SIU
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$ 83200 - 114000
1 Vacancy
Job Description
At Clover Health we are committed to providing highquality affordable and easytounderstand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history we ensure better care at a lower costdelivering the highest value to those who need it most.
The Special Investigation Unit (SIU) is a collaborative team at the crossroads of Compliance Payment Integrity and Data Infrastructure focused on detecting and investigating healthcare fraud waste and abuse (FWA). As an Investigator youll help scale Clovers FWA audit program ensuring regulatory compliance and quality assurance. Youll develop and execute effective audit strategies to identify and report suspected FWA while growing your policy and operational expertise in a fastpaced techdriven healthcare environment.
As an Investigator you will:
- Implement an effective audit strategy to investigate known or suspected instances of FWA.
- Support complex provider conversations around FWA audit findings.
- Prepare response letters to deliver information to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).
- Manage overall audit workload to ensure timely and accurate audit results.
- Act as a FWA subject matter expert.
- Collaborate to identify possible audit opportunities.
- Build strong working relationships with both regulatory and law enforcement agencies.
- Communicate effectively while building trust and lasting partnerships both laterally and vertically across multidiscipline teams.
- Support annual FWA goals.
Success in this role looks like:
- Consistently complete audits within CMS regulatory timeframes.
- Achieve high accuracy rates in audit findings with minimal need for rework.
- Maintain strong trustbased partnerships with internal teams providers and external regulatory bodies.
- Lead provider conversations and regulatory communications with clarity and professionalism resulting in minimal escalations.
- Serve as a goto expert on FWA regulations and policy within the organization.
- Contribute to annual FWA goals by identifying and implementing process improvements or policy recommendations.
You should get in touch if:
- You have 3 years of experience in the healthcare FWA space.
- You have experience identifying operations and process improvement efforts.
- You have an understanding of compliance and payer requirements including Medicare regulations.
- You have knowledge on fraud statutes and regulations and preferably hold certifications like CFE AHFI or similar.
Benefits Overview:
- Financial WellBeing: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally we offer a performancebased bonus program 401k matching and regular compensation reviews to recognize and reward exceptional contributions.
- Physical WellBeing: We prioritize the health and wellbeing 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 WellBeing: We understand the importance of mental health in fostering productivity and maintaining worklife balance. To support this we offer initiatives such as NoMeeting Fridays monthly company holidays access to mental health resources and a generous flexible timeoff policy. Additionally we embrace a remotefirst 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
- Remotefirst culture enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
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 weve 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 missiondriven individuals with diverse areas of expertise working together to solve the most complicated problem in the world: healthcare.
From Clovers 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 peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones responsibility.
#LIRemote
Pursuant to the San Francisco Fair Chance Ordinance we will consider for employment qualified applicants with arrest and conviction records. We are an EVerify company.
For California Colorado New Jersey New York or Washington residents a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.
Colorado/Washington Pay Range:$83200 $114000 USD
California/New Jersey/New York Pay Range:$83200 $125000 USD
Employment Type
Full Time
