Senior Manager Configuration

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.

We are looking for an experienced Senior Manager of Configuration to join our team. In this role you will be responsible for leading and optimizing Clovers Configuration process working closely with both internal and external stakeholders to ensure efficient accurate and timely claims processing. You will ensure accurate setup and compliance with CMS guidelines work crossfunctionally to implement plan designs and benefit configurations and streamline operational processes that support the successful administration of our Medicare Advantage plans. The ideal candidate brings deep Medicare Advantage experience strong leadership skills and a track record of driving operational efficiency and crossfunctional alignment.

As a Configuration Senior Manager you will:

• Work cross functionally with various Operations and Compliance internal stakeholders as well as external BPaaS stakeholders.
• Provide Medicare Advantage configuration oversight:
  • Lead the configuration and implementation of Medicare Advantage plans in alignment with CMS guidelines plan designs member benefits and provider contract terms.
  • Collaborate closely with product operations and compliance teams to ensure accuracy and timeliness in member benefit and provider contract setup and updates.
• Provide compliance and regulatory management:
  • Monitor and interpret CMS regulatory changes impacting Medicare Advantage plans ensuring configurations reflect current requirements.
  • Work with compliance and legal teams to address any discrepancies and maintain adherence to federal and state regulations.
• Collaborate crossfunctionally:
  • Coordinate with data operations IT and other internal teams to facilitate effective plan configuration benefit testing and implementation.
  • Act as the primary contact between configuration and business units to support problemsolving and issue resolution.
• Be responsible for process improvement and automation:
  • Identify and implement process improvements to streamline configuration workflows enhance quality control and drive timely accurate claims processing.
  • Drive the development and integration of automated solutions to improve efficiency and accuracy in plan configuration.
• Provide team leadership and development:
  • Supervise and mentor a team fostering a culture of excellence accountability and continuous learning.
  • Develop and maintain documentation training materials and best practices for configuration procedures.

Success in this role looks like:

• By the end of your 90day period you have seamlessly integrated into the Configuration team and started to establish strong working relationships with key internal and external stakeholders. You have a strong understanding of our Configuration software solutions and have a proven ability to contribute to the strategic planning of pricer and edit enhancements.
• By 6 months you will be immersed and leading the Configuration strategy and .
• Future success in this role will be measured through configuration improvements and improved overall provider experience which will be measured on components including but not limited to decreased claim and clinical disputes and claim reprocessing.

You should get in touch if:

• You have 7 years of experience in Medicare Advantage or healthcare plan configuration with ideally at least 3 years in a managerial or leadership role.
• You are proficient in health plan systems (e.g. HealthEdge Source CES).
• You have comprehensive knowledge of CMS regulations and Medicare Advantage compliance requirements.
• You have a strong understanding of Medicare reimbursement and claims editing
• You demonstrate strong project management problemsolving and decisionmaking abilities.
• You demonstrate excellent verbal and written communication and presentation skills with the ability to communicate complex concepts across multiple disciplines.
• You have training and talent development experience.
• You have experience in crossfunctional stakeholder and vendor management.

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.

#LIREMOTE

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 $104000 to $160000. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.