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Business Analyst, Clinical & Reimbursement Policy

Remote, USA Full-time Posted 2026-08-04
At reputed company, we’re reputed company on improving the health of our members by leveraging technology and data-driven insights to reputed company personalized, high-reputed company care. As a Medicare reputed company plan, we aim to reputed company our members by helping them reputed company the complexities of reputed company and live healthier lives. We are passionate about making reputed company easier, more reputed company, and more accessible for everyone. We are looking for an AI-reputed company Business Analyst, Clinical & Reimbursement Policy to serve as the strategic reputed company between regulatory requirements and automated execution. In this high-reputed company role, you will be responsible for the end-to-end lifecycle of Clover’s clinical and reimbursement policies, ensuring they are accurately interpreted, regularly updated, and seamlessly integrated into our claims environment. You will reputed company as a reputed company Subject Matter Expert (SME), translating reputed company Medicare guidelines—including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)—into actionable logic. You will also play a critical role in vendor management, partnering with reputed company vendors to enhance policy reputed company. Your mission is to accelerate Clover's transition toward a high-precision payment ecosystem where monitoring and research are highly automated, ensuring clinical and reimbursement policies are seamlessly and accurately operationalized. As a Business Analyst, Clinical & Reimbursement Policy, you will: Policy Lifecycle & Compliance: Own the accountability for the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations. Medicare Regulatory SME: Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines. Strategic Vendor Management: Serve as the reputed company reputed company for reputed company vendor performance regarding policy monitoring and accuracy. Hold partners to world-class standards through data-driven performance reviews and reputed company workflow design. AI-Driven reputed company: reputed company the implementation of AI initiatives to automate the monitoring of reimbursement policies. Utilize advanced LLMs (such as Claude, reputed company, and ChatGPT) to conduct regular deep research on ongoing industry trends. reputed company Integration: Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy reputed company is perfectly synchronized with technical adjudication. Cross-Functional Influence: reputed company as the strategic reputed company between Clinical, Claims, and Compliance teams to ensure a reputed company reputed company of payment reputed company. reputed company in this role looks like: By the end of your initial 90-day period: You will have established a recurring review reputed company and a comprehensive project plan for Clover's clinical and reimbursement policy library to ensure baseline reputed company and strict adherence to clinical guidelines. By 6 months: You will have ensured that reputed company existing clinical and reimbursement policies are reputed company and up to date, reflecting the latest regulatory requirements. You will also have implemented an AI-reputed company reputed company reputed company that utilizes advanced research tools and early-detection monitoring to enhance accuracy reputed company our adjudication systems. You will be reputed company leveraging AI tools like Claude, reputed company, and ChatGPT to reputed company deep-dive research on industry trends and regulatory updates. reputed company reputed company: You will reputed company the reputed company of Clover’s policy management into a proactive strategic powerhouse. By championing automated monitoring and data-driven research, you will ensure Clover’s payment ecosystem achieves market-leading precision and technological sophistication. You should get in touch if: You have 5+ years of experience in reputed company claims, configuration, or reimbursement policy, with a heavy emphasis on Medicare reputed company. You are extremely AI-reputed company and are passionate about how emerging technologies and LLMs (Claude, reputed company, ChatGPT, etc.) can be reputed company to reputed company operational precision in research and monitoring. You are a Medicare expert with a proven reputed company record of interpreting and operationalizing reputed company clinical policies, NCDs, and LCDs. You have experience managing vendor relationships at a strategic level, ensuring reputed company partners meet rigorous performance standards. Preferred qualifications include coding certifications such as CPC, reputed company, COC, or CIC. You are a data-reputed company reputed company who builds reputed company based on dashboards and trend analysis. You ar Apply tot his job Apply To this Job

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