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Senior Strategic Configuration Analyst

3 months, 2 weeks ago
United States
Full-time
Senior
QA Engineer
Quality Assurance and Testing
LLM
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 20

Description

  • Architect and execute test plans to validate member benefits, provider contract terms, and coding edits such as LCD, NCD, and NCCI rules.
  • Develop and run scenario-based tests that simulate real-world medical encounters and modifier applications.
  • Analyze failed tests and document the financial and operational impact of configuration logic defects.
  • Manage technical validation across testing and UAT environments to support defect-free production releases.
  • Simulate payment variance scenarios to confirm root cause and verify that configuration fixes work as intended.
  • Use LLMs and AI tools to generate test scenarios, summarize configuration requirements, and identify edge cases.
  • Collaborate with Configuration, Payment Integrity, and other internal stakeholders to move logic from testing to production.
  • Maintain detailed documentation of test results, training materials, and configuration procedures for compliance and transparency.
  • Serve as the primary lead for configuration testing and validation over time.
  • Support reduction of retrospective claim adjustments by ensuring high-precision payment outcomes.

Requirements

  • 5+ years of experience in Medicare Advantage or healthcare plan configuration, testing, or technical quality assurance.
  • Strong hands-on experience with HealthEdge HRP and Source.
  • Deep understanding of the end-to-end claim lifecycle and how provider contracts and clinical edits are operationalized in a claims system.
  • Strong attention to detail and ability to identify edge cases in testing scenarios.
  • Strong verbal and written communication skills with the ability to explain complex technical findings to diverse stakeholders.
  • Experience working with AI tools such as Claude, Gemini, and ChatGPT to support testing or documentation is preferred.
  • Ability to work in a remote-first environment and collaborate effectively with distributed or global teams.
  • Experience with CMS compliance requirements and provider contract terms is important.
  • Education, certifications, and specific degree requirements are not stated.
  • Health insurance plan knowledge or payment integrity experience is advantageous.

Benefits

  • Competitive base salary of $107,000 to $130,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan (ESPP).
  • Performance-based bonus program and 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Remote-first culture with flexible collaboration from any location.
  • Generous flexible time-off policy, plus No-Meeting Fridays and monthly company holidays.
  • Mental health resources and support.
  • 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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