Business Analyst, Clinical & Reimbursement Policy
Clover Health · United States · US
Regulatory Affairs
Remote
Dentist
Demand78
Career growth72
Healthcare fit80
Remote potential65
Salary band
USD 107k – 130k
5-year outlook
Payer policy and reimbursement expertise remains valuable, especially with Medicare Advantage and AI-enabled compliance monitoring. Clinicians who build claims, coding, and regulatory depth may progress into policy management, reimbursement strategy, or healthcare consulting roles, though compensation will vary by market and experience.
Clinical license
Not required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-29
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- Profession fit
- Dentist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for clinicians who already have payer, utilization management, coding, compliance, or Medicare policy exposure and want a non-clinical policy/reimbursement pathway. Clinicians without claims or regulatory experience may find the learning curve steep.
Who should apply
Nurses, doctors, pharmacists, and IMGs with experience in utilization management, Medicare Advantage, clinical policy, coding, compliance, claims, or reimbursement who want to move into payer strategy and AI-enabled policy operations.
CV angle
Frame real clinical experience around guideline interpretation, documentation standards, quality and compliance, cross-functional collaboration, and translating clinical requirements into operational rules. Emphasize any exposure to Medicare, NCDs/LCDs, claims, coding, utilization review, vendor coordination, data analysis, and process improvement without overstating policy ownership.
Skills to highlight
- Medicare regulatory interpretation
- NCD/LCD policy translation
- Reimbursement and claims adjudication knowledge
- Clinical policy lifecycle management
- Vendor performance management
- Cross-functional collaboration with clinical, claims, and compliance teams
- AI/LLM research and workflow automation
- Data-driven policy monitoring and process improvement
Role summary
A payer-side business analyst role at a Medicare Advantage plan, owning clinical and reimbursement policy maintenance, interpreting CMS/NCD/LCD guidance, supporting claims configuration, managing external policy vendors, and using AI tools to monitor regulatory changes.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.