Operations Coordinator, Utilization Management

Summary

Join Clover, a company reinventing health insurance, as a Utilization Management Operations Coordinator. You will partner with vendors, monitor processes, and ensure timely and appropriate care for members. Responsibilities include managing vendor relationships, monitoring key performance indicators, maintaining policies and procedures, and performing quality assurance reviews. Success involves mastering core tasks, improving efficiency, and contributing to process enhancements. The role requires experience in healthcare, customer service, Medicare regulations, and quality assurance. Clover offers competitive compensation, benefits, and professional development opportunities.

Requirements

• Have knowledge and understanding of Medicare Advantage plans and CMS regulations
• Have experience with Medicare insurance regulations
• Have at least 1 - 2 years experience in healthcare and customer service
• Have experience with Microsoft Suite and/or Google Docs
• Have experience working remotely and have an appropriate office space
• Have experience in completing quality assurance reviews

Responsibilities

• Assist with managing vendor relationships for non-clinical Utilization Management (UM), workflows
• Monitor priority cases and report on key performance indicators
• Maintain and organize internal UM policies and procedures
• Support UM projects and process improvement initiatives
• Perform quality assurance (QA) reviews of non-clinical UM processes to ensure accuracy, efficiency, and compliance with regulations
• Assist with data entry and analysis to support UM reporting and decision-making
• Identify and escalate procedural gaps and compliance concerns
• Develop and implement operational SOPs, including training and QA
• Resolve issues escalated by providers and vendors
• Investigate complaints to Medicare (CTM)

Preferred Qualifications

• Enjoy managing large projects that require strong organizational skills and collaborating with a broad array of teams within an organization
• Have acute attention to detail and always strive for perfection when writing formal documents

Benefits

• Competitive hourly rate
• Performance-based bonus program
• 401k matching
• Regular compensation reviews
• Comprehensive medical, dental, and vision coverage
• No-Meeting Fridays
• Company holidays
• Access to mental health resources
• Generous time-off policy
• Full-time hourly employees accrue up to 18 days of vacation per year
• Clover recognizes 10 federal holidays including New Year's Day, Juneteenth, and Christmas. There are also 4 additional paid holidays, 1 floating holiday, and a Week of Rest (the last week of December)
• Learning programs
• Mentorship
• Professional development funding
• Regular performance feedback and reviews
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents