At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care. As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives. We are passionate about making healthcare easier, more affordable, and more accessible for everyone.
We are looking for a strategist and technical Senior Manager of Strategic Configuration to lead the evolution 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 precisely the first time.
In this role, you will lead a lean, agile team, acting as the strategic lead 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 ... Click Apply to read the full job description.