Clover Health

2 months ago

Senior Manager, Strategic Configuration

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 4 hours agoStatus: Live

Job Summary

Strategic, hands-on leader driving first-pass claim payment accuracy for a Medicare Advantage health plan. Oversees a lean, agile team to design and optimize configuration logic, automate processes, and bridge Configuration, Payment Integrity, Clinical Review, and Compliance to deliver industry-leading precision.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Solutions Engineering & Sales Engineering

Seniority: Sr. Manager level

Key Responsibilities

•First-Pass Accuracy Architecture: Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication, synchronizing complex member benefits and provider contracts with accuracy goals.
•Strategic Process Optimization: Identify and address configuration gaps by optimizing edit logic and implementing precision-based review triggers.
•Evolution of Automated Solutions: Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration, using data-forward analytics to mitigate payment inaccuracies.
•Cross-Functional Synergy: Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance to translate regulatory requirements into high-precision configuration logic.
•Lean Team Leadership: Provide hands-on, player-coach leadership for a small, high-impact team, fostering excellence, accountability, and continuous technical learning.

Pay and Benefits

Salary: USD 129,000 - 168,000 annually

Equity and Bonus:Equity

Perks:401kEquityRemote-firstParental LeaveCell PhoneEspp

Key Requirements

•7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role.
•In-the-weeds 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.
•Strong project management and problem-solving abilities with a track record of driving systemic process improvements.
•Passion for leveraging technology and data-driven insights to drive operational precision; excellent verbal and written communication skills.

Experience:HealthcareMedicare AdvantageHealth plan configuration

Skills:CommunicationLeadershipProblem-solvingStrategic thinking

Languages:English

Tech Stack:HealthEdge HRPSourceData analyticsAutomation

Company Brief

Clover Health

Clover Health is a technology-driven health insurance company offering Medicare Advantage plans that combine clinical care coordination, data analytics, and value-based care to improve outcomes and reduce costs for seniors.

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: Jersey City, United States

Founded: 2014

Website LinkedIn

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Clover Health

2 months ago

Senior Manager, Strategic Configuration

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 4 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Solutions Engineering & Sales Engineering

Seniority: Sr. Manager level

Key Responsibilities

•First-Pass Accuracy Architecture: Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication, synchronizing complex member benefits and provider contracts with accuracy goals.
•Strategic Process Optimization: Identify and address configuration gaps by optimizing edit logic and implementing precision-based review triggers.
•Evolution of Automated Solutions: Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration, using data-forward analytics to mitigate payment inaccuracies.
•Cross-Functional Synergy: Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance to translate regulatory requirements into high-precision configuration logic.
•Lean Team Leadership: Provide hands-on, player-coach leadership for a small, high-impact team, fostering excellence, accountability, and continuous technical learning.

Pay and Benefits

Salary: USD 129,000 - 168,000 annually

Equity and Bonus:Equity

Perks:401kEquityRemote-firstParental LeaveCell PhoneEspp

Key Requirements

•7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role.
•In-the-weeds 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.
•Strong project management and problem-solving abilities with a track record of driving systemic process improvements.
•Passion for leveraging technology and data-driven insights to drive operational precision; excellent verbal and written communication skills.

Experience:HealthcareMedicare AdvantageHealth plan configuration

Skills:CommunicationLeadershipProblem-solvingStrategic thinking

Languages:English

Tech Stack:HealthEdge HRPSourceData analyticsAutomation

Company Brief

Clover Health

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: Jersey City, United States

Founded: 2014

Website LinkedIn