Medicare Advantage Enrollment Senior Associate

At Clover Health we are committed to providing highquality affordable and easytounderstand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history we ensure better care at a lower costdelivering the highest value to those who need it most.

The Membership team is dedicated and enthusiastic individuals working at the heart of Medicare Advantage operations. This team maintains the business function of our Enrollment and Billing activities including ensuring accuracy and timeliness of enrollment applications maintaining compliance with the Centers for Medicare & Medicaid Services (CMS) researching and resolving escalated issues and ensuring accurate member data throughout the members journey with Clover.

As a Medicare Advantage Enrollment Senior Associate you will serve as the SubjectMatter Expert (SME) in daily operational and AEP readiness as well as quality assurance activities. You will improve the productivity of Clovers enrollment function through strong organizational skills and operational oversight of the delegated Business Process as a Service (BPaaS) vendor. Furthermore you will be responsible for overseeing and maximizing the relationship with our BPaas vendor through driving daytoday interactions while also ensuring adherence to Service Level Agreements (SLAs) and compliance with CMS regulations and Clovers internal policies and procedures.

As Medicare Advantage Enrollment Senior Associate you will:

• Work autonomously and be motivated to meet and exceed expectations by being action oriented and a high level of attention to detail.
• Understand core objectives when managing change or when issues arise.
• Develop relationships own communications and drive daytoday interactions with the BPaaS team.
• Actively participate in routine calls with the BPaas and maximize team efficiency by gathering all updates prior to calls and meetings.
• Ensure BPaaS team and plan are aligned in terms of expectations performance and release/delivery timeframes.
• Manage the endtoend annual readiness activities to include Annual Enrollment Period (AEP) and MA Open Enrollment Period (OEP).
• Partner with team members to develop and execute audit and oversight plans to include SOX (SarbanesOxley) controls to ensure the accuracy and integrity of data impacting financial reporting and performance.
• Hold BPaaS and/or internal resources accountable to deadlines deliverables and remediation plans. Raise concerns or issues to leadership.
• Research and address issues with the BPaaS. Track and trend incidents change requests and other tickets across multiple platforms.
• Analyze processes and provide recommendations for improvement or remediation of issues.
• Analyze vendor performance in comparison with SLAs and CMS requirements. Develop and maintain vendor performance dashboards.
• Develop and track work plans and assist in establishing operational objectives. Identify appropriate resources to support specific tasks and ensure resources are engaged and performing.

Success in this role looks like:

• By the end of your 90day period you will be responsible for ensuring the accuracy and compliance of the monthly SOX control processes. You will also take ownership of managing crossfunctional escalations related to Enrollment and Billing. Additionally you will independently maintain key KPIs SLAs and Compliance dashboards.
• By the 6months you will be accountable for validating and ensuring the accuracy of Medicare reporting while also ensuring timely submissions. You will serve as the subjectmatter expert for enrollment application processing overseeing the development and of audits across the endtoend process. Additionally you will manage the tracking and delivery of Annual Enrollment Period (AEP) projects to ensure successful and compliant .
• Future success in this role will be measured by your ability to develop and execute monthly quarterly and annual monitoring and auditing of all critical enrollment functions performed by the BPaaS team ensuring compliance with Medicares stringent rules and regulations and safeguarding member access to care. You will map key internal and BPaaS endtoend workflows identifying and recommending improvements. Additionally you will oversee daily operations and provide departmental and crossfunctional support.

You should get in touch if:

• You have 35 years of Medicare Advantage enrollment and billing experience.
• You have a thorough understanding of the Medicare Lifecycle and deep knowledge of Medicare enrollment guidelines.
• You have 13 years of delegated vendor oversight experience.
• You can effectively multitask and are able to create and decipher reports/dashboards and produce presentations and diagrams.
• You are an advanced Excel/G Sheet user able to utilize formulas and functions such as vlookup concatenate countif conditional formatting and data validation in addition to pivot tables. Also important is knowledge of importing .txt files (fixed width or delimited) and converting to .txt or .csv format.
• You are selfmotivated and have the desire to learn and resolve issues.
• You are curious inquisitive and seek to root out details and nuance when analyzing issues or data.
• You are comfortable working autonomously as well crossfunctionally.
• Youre a strong communicator with proven experience developing and maintaining professional relationships.

Benefits Overview:

• Financial WellBeing: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally we offer a performancebased bonus program 401k matching and regular compensation reviews to recognize and reward exceptional contributions.
• Physical WellBeing: We prioritize the health and wellbeing of our employees and their families by providing comprehensive medical dental and vision coverage. Your health matters to us and we invest in ensuring you have access to quality healthcare.
• Mental WellBeing: We understand the importance of mental health in fostering productivity and maintaining worklife balance. To support this we offer initiatives such as NoMeeting Fridays monthly company holidays access to mental health resources and a generous flexible timeoff policy. Additionally we embrace a remotefirst culture that supports collaboration and flexibility allowing our team members to thrive from any location.
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs mentorship professional development funding and regular performance feedback and reviews.

Additional Perks:

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remotefirst culture enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken so weve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and missiondriven individuals with diverse areas of expertise working together to solve the most complicated problem in the world: healthcare.

From Clovers inception Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths experiences perspectives opinions and backgrounds who share a passion for improving peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones responsibility.

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Pursuant to the San Francisco Fair Chance Ordinance we will consider for employment qualified applicants with arrest and conviction records. We are an EVerify company.

A reasonable estimate of the base salary range for this role is $64000 to $99000. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.