Medicare Advantage Enrollment Senior Associate

Summary

Join Clover Health's Membership team as a Medicare Advantage Enrollment Senior Associate and become a Subject-Matter Expert (SME) in daily operations and AEP readiness. You will improve enrollment function productivity through strong organizational skills and operational oversight of the BPaaS vendor. Responsibilities include managing the relationship with the BPaaS vendor, ensuring adherence to SLAs and compliance, and managing annual readiness activities. You will partner with team members on audits and oversight plans, hold resources accountable, research and address issues, analyze processes and vendor performance, and develop work plans. Success will be measured by ensuring accuracy and compliance of SOX control processes, managing escalations, maintaining KPIs and dashboards, validating Medicare reporting, and overseeing audits. Long-term success involves monitoring and auditing enrollment functions, improving workflows, and providing departmental support.

Requirements

• Have 3–5 years of Medicare Advantage enrollment and billing experience
• Have a thorough understanding of the Medicare Lifecycle and deep knowledge of Medicare enrollment guidelines
• Have 1–3 years of delegated vendor oversight experience
• Effectively multitask and be able to create and decipher reports/dashboards and produce presentations and diagrams
• Be 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
• Be self-motivated and have the desire to learn and resolve issues
• Be curious, inquisitive and seek to root out details and nuance when analyzing issues or data
• Be comfortable working autonomously as well cross-functionally
• Be a strong communicator with proven experience developing and maintaining professional relationships

Responsibilities

• 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 day-to-day 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 end-to-end 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 (Sarbanes-Oxley) 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

Benefits

• Competitive base salary and equity opportunities
• Performance-based bonus program
• 401k matching
• Regular compensation reviews
• Comprehensive medical, dental, and vision coverage
• Initiatives such as No-Meeting Fridays
• Monthly company holidays
• Access to mental health resources
• A generous flexible time-off policy
• Remote-first culture
• Learning programs
• Mentorship
• Professional development funding
• Regular performance feedback and reviews
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Paid parental leave for all new parents