Clover health (Utilization management) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.

• Evaluates and processes claims in accordance with company policies and procedures, as well as to productivity and quality standards. Interprets and processes routine and less complex claims including CMS 1500 and UB04.• Reviews and analyses data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication• Set up new patient account & charge entry, and claim status.• Checking Eligibility at the charge Entry time.