Senior Manager, Configuration

Clover Health; United States; Remote; USD 104,000 - 160,000; Full time

Job summary

An established industry player is seeking a Senior Manager of Configuration to enhance Medicare Advantage plans. In this pivotal role, you will lead the configuration processes, ensuring compliance with CMS guidelines while collaborating with various stakeholders. Your expertise will drive operational efficiency and improve member experiences. This role offers the chance to make a significant impact in a mission-driven environment that values diversity and innovation. Join a team dedicated to reinventing healthcare through data and empathy, and help shape the future of health insurance for America's seniors.

Benefits

Health insurance

401(k) plan

Flexible working hours

Remote work options

Professional development opportunities

Qualifications

• 7+ years in Medicare Advantage or healthcare plan configuration.
• Strong managerial experience and knowledge of CMS regulations.

Responsibilities

• Lead Medicare Advantage configuration and compliance oversight.
• Collaborate with cross-functional teams for effective plan implementation.

Skills

Medicare Advantage experience

Leadership skills

Project management

Problem-solving

Communication skills

Education

Bachelor's degree in a relevant field

Tools

HealthEdge

Source

CES

Job description

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.

We are looking for an experienced Senior Manager of Configuration to join our team. In this role, you will be responsible for leading and optimizing Clover’s Configuration process, working closely with both internal and external stakeholders to ensure efficient, accurate, and timely claims processing. You will ensure accurate setup and compliance with CMS guidelines, work cross-functionally to implement plan designs and benefit configurations, and streamline operational processes that support the successful administration of our Medicare Advantage plans. The ideal candidate brings deep Medicare Advantage experience, strong leadership skills, and a track record of driving operational efficiency and cross-functional alignment.

As a Configuration, Senior Manager, you will:

• 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.

Success in this role looks like:

• By the end of your 90-day period, you have seamlessly integrated into the Configuration team and started to establish strong working relationships with key internal and external stakeholders. You have a strong understanding of our Configuration software solutions and have a proven ability to contribute to the strategic planning of pricer and edit enhancements.
• By 6 months, you will be immersed and leading the Configuration strategy and execution.
• Future success in this role will be measured through configuration improvements and improved overall provider experience, which will be measured on components including but not limited to decreased claim and clinical disputes and claim reprocessing.

You should get in touch if:

• 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.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured 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: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share 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. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.

#LI-REMOTE

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are anE-Verify company.

A reasonable estimate of the base salary range for this role is $104,000 to $160,000. 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.