Senior Manager, Configuration

Summary

Join Clover Health, a company dedicated to providing high-quality, affordable healthcare plans for seniors, as a Senior Manager of Configuration. In this role, you will lead and optimize Clover's Configuration process, ensuring efficient and accurate claims processing. You will work closely with internal and external stakeholders, implement plan designs and benefit configurations, and streamline operational processes. The ideal candidate possesses extensive Medicare Advantage experience, strong leadership skills, and a proven track record of driving operational efficiency and cross-functional alignment.

Requirements

• You have 7+ years of experience in Medicare Advantage or healthcare plan configuration, with ideally at least 3 years in a managerial or leadership role
• You are proficient in health plan systems (e.g., HealthEdge, Source, CES)
• You have comprehensive knowledge of CMS regulations and Medicare Advantage compliance requirements
• You have a strong understanding of Medicare reimbursement and claims editing
• You demonstrate strong project management, problem-solving, and decision-making abilities
• You demonstrate excellent verbal and written communication and presentation skills, with the ability to communicate complex concepts across multiple disciplines
• You have training and talent development experience
• You have experience in cross-functional stakeholder and vendor management

Responsibilities

• Work cross functionally with various Operations and Compliance internal stakeholders as well as external BPaaS stakeholders
• Provide Medicare Advantage configuration oversight : Lead the configuration and implementation of Medicare Advantage plans in alignment with CMS guidelines, plan designs, member benefits, and provider contract terms
• Collaborate closely with product, operations, and compliance teams to ensure accuracy and timeliness in member benefit and provider contract setup and updates
• Provide compliance and regulatory management : Monitor and interpret CMS regulatory changes impacting Medicare Advantage plans, ensuring configurations reflect current requirements
• Work with compliance and legal teams to address any discrepancies and maintain adherence to federal and state regulations
• Collaborate cross-functionally: Coordinate with data, operations, IT, and other internal teams to facilitate effective plan configuration, benefit testing, and implementation
• Act as the primary contact between configuration and business units to support problem-solving and issue resolution
• Be responsible for process improvement and automation: Identify and implement process improvements to streamline configuration workflows, enhance quality control, and drive timely, accurate claims processing
• Drive the development and integration of automated solutions to improve efficiency and accuracy in plan configuration
• Provide team leadership and development: Supervise and mentor a team, fostering a culture of excellence, accountability, and continuous learning
• Develop and maintain documentation, training materials, and best practices for configuration procedures

Benefits

• Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities
• Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions
• We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage
• Your health matters to us, and we invest in ensuring you have access to quality healthcare
• We understand the importance of mental health in fostering productivity and maintaining work-life balance
• To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy
• Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location
• Developing internal talent is a priority for Clover
• We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents