Business Analyst – Appeals & Grievances
Employment Information
Job Description
Business Analyst transforming data into actionable insights to improve member experience at Clover Health. Collaborating with teams to streamline operations and ensure compliance in Medicare Advantage services.
Responsibilities:
- Deliver timely daily and weekly operational reports to track case volumes, timeliness, and performance against KPIs.
- Validate A&G case inventory for accuracy, completeness, and compliance with CMS requirements.
- Analyze operational data to identify trends, root causes, and opportunities for process improvement.
- Collaborate with Operations, Compliance, and IT to implement workflow enhancements and regulatory updates.
- Support the development and integration of CMS and organizational guidance into operational systems.
- Partner with the Quality and STARS teams to monitor decision-making metrics and drive performance improvements.
- Prepare for audits by ensuring reporting and documentation are accurate, comprehensive, and audit-ready.
- Provide data-driven insights to cross-functional partners and governance committees to enhance member experience.
Requirements:
- You have 2+ years of experience in healthcare operations, business analysis, or compliance (A&G/Medicare Advantage experience strongly preferred).
- You’re highly skilled in data analysis and problem-solving, with the ability to spot trends and validate large data sets.
- You have experience producing operational dashboards and reports using Excel and BI tools (SQL, Tableau, Power BI a plus).
- You’re familiar with CMS regulations and Complaint Tracking Module (CTM) processes.
- You excel at communicating insights clearly and collaborating across Operations, Compliance, and IT teams.
- You thrive in a fully remote environment and are based in the U.S. Central or Eastern time zones (working primarily on ET hours).
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
- And much more!
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