[All remote jobs](https://jobicy.com/jobs.md)Open role[![Clover Health logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/8d4e74b3-221.jpg)](https://jobicy.com/company/clover-health.md)Remote opportunity at[Clover Health](https://jobicy.com/company/clover-health.md) # Business Analyst, Clinical & Reimbursement Policy Review the role, location requirements, compensation details, and application process before deciding whether this opportunity fits your next career move. [Apply for this job](#job-application)[View company](https://jobicy.com/company/clover-health.md)Share17 Aug 2026Published40Listing views4Application actions16 Sep 2026Apply before Opportunity details ## About this role. AI SummaryThis remote US role owns the lifecycle of clinical and reimbursement policies for a Medicare Advantage insurer. The analyst will interpret CMS guidance, including NCDs, LCDs, and national coding requirements, and translate it into operational claims-adjudication logic. Core responsibilities include policy governance, strategic vendor oversight, data-driven quality monitoring, and alignment across clinical, claims, compliance, configuration, and data science teams. The position also emphasizes using LLMs and AI-enabled research workflows to automate regulatory monitoring and improve payment accuracy. ## Role DNA A quick view of the complexity, pace, ownership and collaboration implied by the job description. ### Job Complexity 5/5EasyHard ### Pace & Pressure 4/5RelaxedFast-paced ### Autonomy Level 5/5GuidedFull ownership ### Communication Load 5/5IndependentCollaborative AI insightThis is a senior specialist role requiring deep Medicare Advantage reimbursement expertise, including practical interpretation of NCDs, LCDs, coding guidance, and claims configuration impacts. The incumbent must independently drive policy governance while coordinating vendors and several technical, clinical, and compliance stakeholders. ## Salary analysis Estimated compensation compared with the broader US market for similar roles. Estimated job medianMarket rate$118,500US market range$100k–$145k0$160k AI insightThe posting explicitly discloses a US base salary range of $107,000 to $130,000 USD. The offered midpoint is $118,500 yearly. A comparable US-market base-salary range for a senior Medicare reimbursement and clinical policy business analyst is estimated at $100,000 to $145,000 annually; actual pay may vary by experience, certifications, and location. ## Core skills Skills and capabilities most closely associated with this opportunity. [Medicare Advantage](https://jobicy.com/jobs?search_keywords=Medicare%20Advantage.md)[Clinical Policy](https://jobicy.com/jobs?search_keywords=Clinical%20Policy.md)[Reimbursement Policy](https://jobicy.com/jobs?search_keywords=Reimbursement%20Policy.md)[CMS Compliance](https://jobicy.com/jobs?search_keywords=CMS%20Compliance.md)[NCD Interpretation](https://jobicy.com/jobs?search_keywords=NCD%20Interpretation.md)[LCD Interpretation](https://jobicy.com/jobs?search_keywords=LCD%20Interpretation.md)[Claims Adjudication](https://jobicy.com/jobs?search_keywords=Claims%20Adjudication.md)[Claims Configuration](https://jobicy.com/jobs?search_keywords=Claims%20Configuration.md)[Vendor Management](https://jobicy.com/jobs?search_keywords=Vendor%20Management.md)[AI Research](https://jobicy.com/jobs?search_keywords=AI%20Research.md) Cover letter sampleDear Hiring Team, I am excited to apply for the Business Analyst, Clinical & Reimbursement Policy role. My background in Medicare Advantage claims, reimbursement policy interpretation, and cross-functional operationalization would enable me to translate NCDs, LCDs, and coding guidance into accurate claims-adjudication logic. I bring a data-driven approach to policy governance, vendor oversight, and compliance monitoring, with a focus on measurable quality and timely regulatory updates. I am also eager to apply responsible AI and LLM-enabled research workflows to strengthen policy surveillance and identify emerging reimbursement changes. I would welcome the opportunity to help Clover build a precise, proactive payment ecosystem that improves member access and affordability. Sincerely, Candidate Copy Sample interview questionsHow would you translate a new or revised Medicare coverage determination into claims-adjudication logic?I would begin by identifying the governing CMS source, effective date, covered indications, limitations, coding requirements, and any applicable local MAC guidance. I would convert those requirements into traceable decision rules, review them with clinical, compliance, and configuration partners, and validate them through test claims and exception scenarios before release. How do you hold an external policy-monitoring vendor accountable for quality and accuracy? I would establish vendor scorecards covering update timeliness, regulatory-source accuracy, completeness, defect rates, turnaround time, and remediation performance. Regular reviews would focus on trend data and root causes, with documented corrective-action plans, owners, due dates, and validation criteria for closure. What is your approach to using LLMs responsibly in reimbursement-policy monitoring? I would use AI as a research and monitoring accelerator rather than as an unreviewed source of policy decisions. For example, I would use LLMs to summarize regulatory updates, compare versions of policies, and flag potential changes, then require SME validation, source citations, audit logs, and controlled implementation workflows. How would you organize the first 90 days of a clinical and reimbursement policy-library review? I would create a centralized inventory with policy owners, source references, effective dates, review cadence, adjudication dependencies, and risk ratings. I would prioritize policies with high claim volume, recent regulatory change, elevated denial or appeal trends, and known configuration complexity, then track progress through a recurring governance dashboard. Describe how you would address a discrepancy between policy intent and claims-system adjudication. I would investigate the issue using claims outcomes, configuration history, policy language, coding data, and member/provider impact. After confirming the root cause, I would coordinate a controlled correction, test impacted scenarios, assess whether reprocessing or communication is required, and implement monitoring to prevent recurrence. At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care. As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives. We are passionate about making healthcare easier, more affordable, and more accessible for everyone. We are looking for an AI-forward Business Analyst, Clinical & Reimbursement Policy to serve as the strategic bridge between regulatory requirements and automated execution. In this high-impact 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 act as a primary Subject Matter Expert (SME), translating complex 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 external vendors to enhance policy oversight. 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 primary oversight for external vendor performance regarding policy monitoring and accuracy. Hold partners to world-class standards through data-driven performance reviews and collaborative workflow design. * AI-Driven Evolution: Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies. Utilize advanced LLMs (such as Claude, Gemini, and ChatGPT) to conduct regular deep research on ongoing industry trends. * System Integration: Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy intent is perfectly synchronized with technical adjudication. * Cross-Functional Influence: Act as the strategic bridge between Clinical, Claims, and Compliance teams to ensure a unified vision of payment excellence. Success in this role looks like: * By the end of your initial 90-day period: You will have established a recurring review framework and a comprehensive project plan for Clover’s clinical and reimbursement policy library to ensure baseline quality and strict adherence to clinical guidelines. * By 6 months: You will have ensured that all existing clinical and reimbursement policies are current and up to date, reflecting the latest regulatory requirements. You will also have implemented an AI-forward oversight framework that utilizes advanced research tools and early-detection monitoring to enhance accuracy within our adjudication systems. You will be actively leveraging AI tools like Claude, Gemini, and ChatGPT to perform deep-dive research on industry trends and regulatory updates. * Continued success: You will lead the evolution 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 healthcare claims, configuration, or reimbursement policy, with a heavy emphasis on Medicare Advantage. * You are extremely AI-forward and are passionate about how emerging technologies and LLMs (Claude, Gemini, ChatGPT, etc.) can be applied to drive operational precision in research and monitoring. * You are a Medicare expert with a proven track record of interpreting and operationalizing complex clinical policies, NCDs, and LCDs. * You have experience managing vendor relationships at a strategic level, ensuring external partners meet rigorous performance standards. * Preferred qualifications include coding certifications such as CPC, CCS, COC, or CIC. * You are a data-focused professional who builds strategy based on dashboards and trend analysis. * You are familiar with enterprise claims engines and understand how these systems interact to drive adjudication accuracy. Benefits Overview: * Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. * Physical Well-Being: We prioritize the health and well-being 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 Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first 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 * Remote-first 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 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, perspectives, opinions, 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. #LI-REMOTE 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](https://e-verify.uscis.gov/esp/media/resourcesContents/E-Verify_Participation_Poster.pdf) company. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc. A reasonable estimate of the base salary range for this role is: $107,000—$130,000 USD Show more [Apply now >](https://jobicy.com/jobs/150918-business-analyst-clinical-reimbursement-policy.md) * ![Upload CV](data:image/svg+xml;base64,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) ### Upload your resume now To unlock remote work opportunities and be discovered by global employers. 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