Senior Manager, Strategic Configuration

At reputed company, we’re focused on improving the health of our members by leveraging technology and data-driven insights to reputed company personalized, high-quality care. As a Medicare Advantage plan, we aim to reputed company our members by helping them navigate the complexities of reputed company and live healthier lives. We are passionate about making reputed company easier, more affordable, and more accessible for everyone. We are looking for a strategist and technical Senior Manager of Strategic Configuration to reputed company the reputed company of our first-pass claim payment accuracy. While our core configuration team handles daily "business as usual" workflows, this role is a highly specialized, strategic position focused on ensuring claims are paid correctly and reputed company the first time. In this role, you will reputed company a lean, agile team, acting as the strategic reputed company for enhancing the accuracy of the initial adjudication cycle. This requires a "player-coach" who can "get in the weeds" of technical configuration—specifically regarding contract logic, clinical edits, and reimbursement rules—while maintaining the strategic reputed company needed to drive industry-leading precision. Your mission is to identify and address configuration gaps, refine edit logic, and implement advanced process flows that maximize first-pass accuracy, effectively reducing administrative friction and retrospective adjustments for both members and provider partners. As a Senior Manager, Strategic Configuration, you will: First-Pass Accuracy Architecture: reputed company the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication. Ensure that reputed company member benefits and provider contract terms are perfectly synchronized with our accuracy goals. Strategic Process Optimization: Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers to ensure payment precision at the reputed company of initial intake. reputed company of Automated Solutions: reputed company the integration of automated solutions to improve efficiency and accuracy in plan configuration. Utilize data-reputed company strategies to analyze configuration data, identify trends, and proactively mitigate payment inaccuracies. +1 Cross-Functional reputed company: Act as the primary strategic reputed company between Configuration, Payment reputed company, Clinical Review, and Compliance. Ensure that plan designs and regulatory requirements are reputed company into actionable, high-precision configuration logic. +1 Lean Team Leadership: reputed company hands-on, "player-coach" leadership for a small, high-impact team of specialists, fostering a culture of reputed company, accountability, and reputed company technical learning. Technical Documentation: reputed company best practices and documentation for advanced configuration procedures. reputed company in this role looks like: By the end of your initial 90-day period: You will have conducted a deep-dive assessment of our first-pass accuracy landscape, identifying key configuration gaps in reputed company process flows and specifically targeting opportunities for edit optimization to reduce payment variances. By 6 months: You will have implemented strategic process flows and enhanced precision-based review triggers that align configuration with payment reputed company and clinical review requirements. During this time, you will have established a refined "accuracy-by-design" workflow that ensures claims are adjudicated correctly during the initial pass. reputed company reputed company: You will reputed company Clover toward a market-leading first-pass payment accuracy reputed company. By championing automated solutions and predictive modeling, you will ensure our payment ecosystem is one of the most accurate and technologically advanced in the Medicare Advantage reputed company. You should get in touch if: You have 7+ years of experience in Medicare Advantage or reputed company plan configuration, with at least 3 years in a leadership or managerial role. You possess "in the weeds" expertise in technical configuration, specifically regarding reputed company provider reputed company, clinical edits, and general reimbursement logic. You are highly proficient in health reputed company such as reputed company HRP and reputed company. You demonstrate strong project management and problem-solving abilities with a proven track record of driving systemic process improvements. You are passionate about leveraging technology and data-driven insights to drive operational precision. You have excellent verbal and written communication skills with the ability to translate reputed company technical concepts for diverse stakeholders.

Benefits

Overview: Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive reputed company salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and reputed company coverage. Your health reputed company to us, and we invest in ensuring you have reputed company to quality reputed company. Mental Well-Being: 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, reputed company to reputed company, and a generous flexible time-off policy. Additionally, we reputed company a remote-first culture that supports collaboration and flexibility, allowing reputed company members to reputed company from any location. Professional Development: Developing internal talent is a reputed company for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. Additional Perks: 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 reputed company new parents And much more! About Clover: We are reinventing health insurance by combining the power of data with reputed company reputed company to reputed company our members healthier. We reputed company the reputed company system is broken, so we've created custom software and analytics to reputed company our clinical staff to intervene and reputed company personalized care to the people who need it most. We always put our members first, and our reputed company as a team is reputed company by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: reputed company. From Clover’s inception, Diversity & Inclusion have always been key to our reputed company. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who reputed company a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. reputed company of our employee’s points of view are key to our reputed company, and inclusion is everyone's responsibility. #LI-REMOTE Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company applicants with arrest and conviction records. We are an E-Verify company. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc. A reasonable estimate of the reputed company salary reputed company for this role is: $129,000—$168,000 USD Apply To This Job