Clover Health · 1 day ago
Investigator, SIU
United States
Full-time
Remote
Mid Level
$83K/yr - $125K/yr
3+ years expClover Health is committed to providing high-quality healthcare plans for America’s seniors, leveraging data and technology for better care. The Investigator role in the Special Investigation Unit focuses on detecting and investigating healthcare fraud, waste, and abuse, ensuring regulatory compliance and quality assurance through effective audit strategies.
Health CareHealth InsuranceHospitalMedical
Responsibilities
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 multi-discipline teams
Support annual FWA goals
Qualification
Required
3+ years of experience in the healthcare FWA space
Experience identifying operations and process improvement efforts
Understanding of compliance & payer requirements including Medicare regulations
Knowledge on fraud statutes and regulations
Preferred
Certifications like CFE, AHFI, or similar
Benefits
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
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
Fierce Healthcare
2026-01-19
2026-01-16
Company data provided by crunchbase