Director, Fraud Investigations

Clover Health’s legal team is a group of proactive business partners whose mission is to empower the organization to innovate and achieve its goals within a dynamic and fluid regulatory environment. We are committed to supporting continued excellence for our customers while building a sustainable future for the organization. We believe integrity, collaboration, and sustainability ensures Clover Health exceeds its objectives, while upholding the highest standards of legal and ethical responsibility. Clover Health is investing in our fraud detection and investigation capabilities, and we are looking for a Director, Fraud Investigations to join our Legal department as a senior individual contributor. This role is an extension of our Special Investigations Unit (SIU) that sits within Legal—you will spend your days investigating suspected fraud against Clover s Medicare Advantage business and ensuring that those investigations are coordinated, well-documented, and supported by the right legal advice from the Legal department. Reporting to Clover s Legal department, you will own a portfolio of fraud investigations end-to-end. Those investigations will originate from SIU s standard intake processes as well as other channels. In every case, you will dig in, gather and analyze the facts, partner with stakeholders across the company, and reach a defensible conclusion. This is a non-attorney role. You will not be providing legal advice yourself; instead, you will work hand-in-hand with Clover s lawyers to make sure your investigations have the legal guidance they need, and that referrals, recoveries, and provider actions are appropriately reviewed by counsel. You are sharp, creative, and technology-forward, and you see AI and data analytics not as threats to the craft of investigation but as the most exciting tools to enter the field in a generation. As a Director, Fraud Investigations, you will: Investigate Suspected Fraud End-to-End: Own a portfolio of fraud investigations from intake through resolution. Develop investigative plans, gather and analyze evidence (including claims data, medical records, and provider documentation), interview witnesses where appropriate, and reach well-supported conclusions. Handle Ad Hoc Internal Referrals: Take on investigations triggered by referrals from senior leaders and other internal stakeholders—e.g., a suspected provider outlier or a tip about potentially anomalous behavior—and provide a clear, factual assessment of whether