Director, AI-Enabled Fraud Prevention & Investigations

Clover Health · Job · via Jobicy

Type
Job
Organization
Clover Health
Location
USA
Deadline
Rolling or not stated
Remote
Yes
Who can apply
People living in United States
Posted
2 October 2026
Skills mentioned
SQL, Python

Apply — via Jobicy

About this Opportunity

Clover Health is investing in our fraud detection and investigation capabilities and is seeking a Director, AI-Enabled Fraud Prevention & Investigations to join our Legal department as a senior individual contributor. This hybrid role combines: (1) managing hands-on investigations of potential provider fraud with (2) building AI-powered tools and processes to make investigations more efficient and help catch potential future fraud earlier.

Eligibility

  • You have experience in healthcare fraud investigations, program integrity, or SIU operations, ideally within Medicare Advantage or managed care.
  • You understand healthcare fraud schemes and know how to use claims data, medical records, and provider documentation to build a defensible factual record.
  • We do not expect production-grade engineering or require formal technical training—we value demonstrated ability to build, ship, and showcase solutions that work.
  • Strong communication skills: You are a strong writer and commu

Documents you may need

  • Updated CV / Resume
  • Cover Letter (tailored to this role)
  • Portfolio / Work Samples
  • Medical Certificate

How to apply

  1. Click the "Apply — via Jobicy" button to go to the source page.
  2. Read the full description and confirm you meet the requirements.
  3. Prepare your CV and cover letter tailored to this role.
  4. Submit your application through the official portal.
  5. Follow up within 1–2 weeks if you do not hear back.

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