Senior Manager, Strategic Configuration
New
C
Clover HealthHealthcare
Remote-first culture, enabling collaboration with global teamsFull-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 ManagementData Analysis
Requirements
- 7+ years of experience in Medicare Advantage or healthcare plan configuration.
- 3+ years of experience in a leadership or managerial role.
- Deep technical expertise in complex provider contracts and clinical edits.
- Strong understanding of general healthcare reimbursement logic.
- Proficiency in health plan systems such as HealthEdge HRP and Source.
- Proven track record of driving systemic process improvements.
- Demonstrated project management and problem-solving abilities.
- Ability to translate complex technical concepts for diverse stakeholders.
- Strong verbal and written communication skills.
- Passion for leveraging technology and data-driven insights to drive operational precision.
Responsibilities
- Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication.
- Ensure complex member benefits and provider contract terms are perfectly synchronized with accuracy goals.
- Identify and address configuration gaps by optimizing edit logic and implementing precision-based review triggers.
- Integrate automated solutions and utilize data-forward strategies to proactively mitigate payment inaccuracies.
- Serve as the strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance departments.
- Provide hands-on leadership for a team of specialists to foster a culture of excellence and accountability.
- Develop best practices and technical documentation for advanced configuration procedures.
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