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Clover Health

Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.

Configuration Director
San Francisco, CA, US
Job Description / Skills Required

Clover is reinventing health insurance by working to keep people healthier.

The Configuration team is a group of hard-working, dedicated analysts working at the heart of Insurance Operations. This team maintains the business function of our insurance system activities, including working with the operations teams (Claims, Enrollment, Network Management, etc.) to understand their day to day needs, resolving escalated issues, and configuring our claims system. The team also works on projects to improve the efficiency and accuracy of all insurance operations. The success of the Insurance Operations department relies on collaboration with our internal counterparts: Membership, Utilization Management, Appeals, Grievances, Customer Service, and Provider Data.

As a Configuration Director at Clover, you will play an active role in executing on a strategy that will enable Insurance Operations to scale efficiently to meet the demands of the organization. In addition, you will play a primary role in developing, managing, and scaling a team within Insurance Operations which includes integration with key business partners, systems analysis and configuration, monitoring, audit preparation, and testing for quality and accuracy. We are looking for a candidate with strong experience in health system implementations, operational configuration management (provider contract, claims and benefits), leading teams to high-quality outcomes, and has a strong conviction that health insurance can and should be better. The Configuration Director will conceptualize and drive execution of operational workflows, and logistics in a way that is iterative, data-driven, and with an eye towards technology-enabled scalability.

As a Configuration Director, you will:

  • Develop processes and controls to ensure that all business configurable data within the claims system is understood, configured and tested before being deployed into the production claims system.
  • Plan staffing and workloads effectively to ensure internal service levels are maintained during peak configuration seasons for benefits and provider contracts.
  • Develop and execute on a strategy to reduce avoidable errors within claims processing to drive a more positive provider and member experience.
  • Lead a team in building configuration processes from the ground up, including designing key configuration data and business logic.
  • Drive strategy of Clover's claims system towards business goals: maximizing auto-adjudication and ensuring 100% claims processing accuracy.
  • Develop and maintain test cases and a testing framework to ensure accuracy through any configuration changes.
  • Interface across broader Operations teams to understand and prioritize improvement areas, and proactively drive changes that will increase team efficiency and accuracy.
  • Collaborate with Product Managers to develop and maintain key integrations between and across Clover insurance systems.
  • Develop and maintain other related adjudication and eligibility configurations.
  • Develop a strategy to cross train staff to be proficient in multiple configuration disciplines (claims, provider contracts, benefits etc.).
  • Support the entire Clover organization with escalation support for claims-related inquiries with a root cause in configuration.
  • Ensure Clover compliance with all CMS claims regulations.

You will love this job if:

  • You are a great communicator and able to communicate across different teams and upward to senior leadership. 
  • You are a strategic prioritizer, and able to identify where and when to focus your energy.
  • You are a problem solver and like getting your hands dirty with the details of a gnarly problem.
  • You love data and using it to make metric-driven decisions.
  • You are passionate about healthcare and opportunities for improving the lives of insurance members.

You should get in touch if:

  • You have 7+ years of relevant technical experience in health insurance software configuration or systems implementation.
  • You are an experienced team lead or have been a lead analyst within implementations.
  • You have experience working in provider, benefits and/or claims configurations.
  • You have a working knowledge of provider contracts and Medicare claims payment methodologies.
  • You have proven experience working with analytical tools. Major plus if you come with SQL skills.

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