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Senior Manager, Strategic Configuration

3 weeks, 6 days ago
United States
Full-time
Senior
Operations Manager
Project and Program Management
Agile
Apply Now
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised
View All Jobs 32

Description

  • Lead the technical design and implementation of strategic configuration logic for first-pass claim adjudication accuracy.
  • Optimize edit logic and precision-based review triggers to reduce payment variances and configuration gaps.
  • Integrate automated solutions to improve the efficiency and accuracy of plan configuration.
  • Analyze configuration data to identify trends and proactively mitigate payment inaccuracies.
  • Serve as the primary bridge between Configuration, Payment Integrity, Clinical Review, and Compliance teams.
  • Translate plan designs and regulatory requirements into actionable configuration logic.
  • Provide hands-on leadership and coaching for a small team of specialists.
  • Develop best practices and documentation for advanced configuration procedures.
  • Assess current first-pass accuracy workflows and implement process improvements over time.
  • Champion predictive and data-driven approaches to improve payment integrity.

Requirements

  • 7+ years of experience in Medicare Advantage or healthcare plan configuration.
  • At least 3 years of leadership or managerial experience.
  • Deep technical configuration expertise with complex provider contracts, clinical edits, and reimbursement logic.
  • Proficiency with HealthEdge HRP and Source.
  • Strong project management and problem-solving skills with a track record of systemic process improvement.
  • Excellent verbal and written communication skills.
  • Ability to translate complex technical concepts for diverse stakeholders.
  • Experience working in a remote-first environment is preferred.
  • Familiarity with automation or predictive modeling is preferred.
  • Education, work experience, and certifications may be considered in compensation decisions.

Benefits

  • Competitive base salary of $129,000 to $168,000 USD.
  • Equity opportunities, including Employee Stock Purchase Plan (ESPP).
  • Performance-based bonus program and 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Remote-first culture with flexibility to work from any location.
  • No-Meeting Fridays and monthly company holidays.
  • Access to mental health resources and a generous flexible time-off policy.
  • Learning programs, mentorship, professional development funding, and regular performance feedback.
  • Reimbursement for office setup expenses and a monthly cell phone and internet stipend.
  • Paid parental leave for all new parents.

Interested in this position?

Apply directly on the company website

Apply Now

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