Senior Manager, Strategic Configuration
New
C
Clover HealthHealth Insurance
Remote - USAFull-TimeManager
Salary129,000 - 168,000 USD per year
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Job Details
- Experience
- 7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role.
- Required Skills
- Project Management
Requirements
- 7+ years of experience in Medicare Advantage or healthcare plan configuration.
- At least 3 years in a leadership or managerial role.
- Expertise in technical configuration, complex provider contracts, clinical edits, and reimbursement logic.
- Proficiency in HealthEdge HRP and Source systems.
- Proven track record of driving systemic process improvements.
- Strong project management and problem-solving abilities.
- Excellent verbal and written communication skills.
- Ability to translate complex technical concepts for diverse stakeholders.
Responsibilities
- Lead the technical design and implementation of strategic configuration logic for first-pass adjudication.
- Ensure complex member benefits and provider contract terms are synchronized with accuracy goals.
- Identify and address configuration gaps by optimizing edit logic and precision-based review triggers.
- Lead the integration of automated solutions for plan configuration efficiency.
- Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance.
- Provide hands-on player-coach leadership for a team of specialists.
- Develop best practices and documentation for advanced configuration procedures.
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