Senior Manager, Strategic Configuration
New
C
Clover HealthHealthcare, Health Insurance
United StatesFull-TimeManager
Salary$129,000—$168,000 USD
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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.
- 3+ years in a leadership or managerial role.
- Expertise in technical configuration, specifically regarding complex provider contracts, clinical edits, and general reimbursement logic.
- Proficiency in health plan systems such as HealthEdge HRP and Source.
- Demonstrated project management and problem-solving abilities.
- Proven track record of driving systemic process improvements.
- Strong verbal and written communication skills for translating technical concepts for diverse stakeholders.
- Passion for leveraging technology and data-driven insights for operational precision.
Responsibilities
- Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication.
- Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers.
- Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration.
- Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance.
- Provide hands-on leadership for a small team of specialists, fostering a culture of excellence and continuous technical learning.
- Develop best practices and documentation for advanced configuration procedures.
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