Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.
Our Insurance Operations teams are working to design, build and implement systems that help Clover succeed. We believe the key driver of our ability to improve health outcomes for our members and affect change in the healthcare system, will be through their experience with the health plan.
In this role, you’ll work closely with every major stakeholder across Clover to ensure that our growing processes reflect our values, our dedication to Compliance and our commitment to the highest quality data possible. You'll have a direct view into how Clover is serving members, providers and CMS today. You’ll manage a growing team of Claims Operations Leads as they support their teams on the front lines, optimize the service Clover is delivering and execute on strategic opportunities to improve the Clover Insurance Operation overall.
As a Senior Director of Insurance, you will:
Investigate operational gaps within claims processes
Identify and re-design inefficient workflows
Strategize, implement and execute programs to prevent fraud, waste and abuse
Collaborate with key stakeholders and departments across the organization to resolve payment issues
Provide feedback to help build product and technology roadmaps
Work closely with Engineering, Product, Operations and Finance teams and serve as the primary point of contact for payment integrity
Assess emerging claims trends and provide strategies for improved payment and, insightful, detail-oriented reporting on those trends
Resolve challenging revenue cycle situations and issues relating to payments and payment integrity
Build strong, high functioning teams and processes to support payment accuracy and integrity as part of Clover's growing operation
Foster an environment that makes claims transparent and learnable by sharing context widely with the company as well as encouraging confident decision-making on your teams
You will love this job if:
You are passionate about solving problems; you can roll your sleeves up, dig into details and mentor your teams to do the same.
You are humble; as a manager of people, you are there to support your teams and ensure they are set up for success.
You are tech and data forward; you’re used to thinking about how technology can enable better operational delivery and how you can use data to make better decisions.
You are collaborative; you recognize it takes a village to build and maintain a successful insurance operation
You can distill the needs of your customers and team members down to actionable improvements that can be made in Clover's product or procedures. And, you can do all of it while keeping Clover compliant and fiercely protecting the privacy and rights of our customers.
You should get in touch with us if:
You have three plus years of medical claims processing and adjustment experience
You have experience with CMS rules and regulations in coding and billing compliance
You understand outpatient billing or charge captures, chart reviews and coding, payers and reimbursement
You have strong verbal, written and interpersonal communication skills
You have experience managing high functioning, tech-forward teams
You have experience with Third Party Administrators
You are a strong verbal and written communicator
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.