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Clover Health

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

Medicare Advantage Plan Design Specialist
United States of America
Job Description / Skills Required

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

We have the potential to change lives on a massive scale with our innovative approach to healthcare and it all starts with our ability to deliver that message to the people who need it most. 

We are seeking a Medicare Advantage Plan Design Specialist to join our Growth team. This is a hybrid role that requires both a deep understanding of Clover's local market dynamics and their impact on the success of the business and Clover's mission along with the curiosity and analytical skills to leverage data in unique ways to develop truly compelling plan designs which contribute to the health and well-being of our members. You will be a trusted, strategic partner that supports and drives our overall Growth team and strategy forward.

As a Medicare Advantage Plan Design Specialist you will be responsible for understanding Medicare Advantage plans, surveying competitive and member preference data, and coordinating the development of Clover’s Medicare Advantage product strategy and benefit plan designs.

As a MA Plan Design Specialist, you will:

  • Perform competitive Analysis of our markets' product offerings, including gathering information from the sales function and publically available CMS data, and serve as the subject matter expert regarding competitive products and plan design in the market.
  • Coordinate across Sales, Marketing, Network, Actuarial, Compliance, Growth Analytics, Clinical, Operations and the Management Team to formulate, recommend, and communicate product strategy and benefit designs for pricing during the bid cycle.  
  • Provide cross-functional program management support of the bid process, including scheduling, conducting and documenting workgroup meetings as required
  • Collaborate with Plan Operations business analysts on end to end Ops Readiness for new plan years.
  • Serve as a subject matter expert for stakeholders (Actuarial, Compliance, Configuration, Marketing, etc.) regarding benefits when it comes to what should be included in the BPT's, PBP's, member/provider facing communications, and configuration.
  • Collect and analyze data to assess and monitor plan performance against defined goals and criteria, prepare and present summary reports to stakeholders, and identify opportunities for improvement. 
  • Keep on top of industry trends from a Medicare product and benefit perspective by market.
  • Keep on top of new benefit and product options defined by CMS.

You will love this job if:

  • You are passionate about growth drivers, the realities of the competitive landscape and how we can increase our competitive advantage in each market we operate in.
  • You are driven by Clover's mission. You are excited to help bring Clover’s rich benefits and unique membership experience to a wider audience.
  • You are a team player. You want to work collaboratively to find new solutions, and you enjoy increasing the capabilities of others.
  • You have a research mindset. You're not afraid of the unknown and love thinking “outside of the box.”
  • You are agile, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action.
  • You are highly analytical and hypothesis driven, anchoring on data to drive first principles thinking.
  • You are structured and organized in the way you think about the work at hand and know how to prioritize.

You should get in touch if:

  • You have 5+ years of experience in a health insurance organization, with 3 years of experience in Medicare products.
  • You have experience working with benefit design, provider networks, medical management, marketing strategies and tactics,and claims required. 
  • You have excellent analytical, project management, writing, and presentation skills, required.
  • You have an ability to interpret CMS communications including memos, guidance, Advanced call letter and Final Call letter for impacts to products during the year and for impact to benefit design.
  • You have an understanding of Original Medicare, Medicare Advantage regulations, and Medicare Part-D benefits.

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.

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 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.