Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.
Clover is reinventing health insurance by working to keep people healthier.
The Configuration team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of Insurance Operations. This team maintains the business function of our insurance system activities, including working with the operations teams 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 Analyst, Senior Associate at Clover you will play an active role in developing, managing, and scaling a team within Insurance Operations which includes systems analysis and configuration, monitoring, audit preparation, and quality accuracy. We are looking for a candidate with strong experience in health system implementations and who has a strong conviction that health insurance can and should be better. We are looking for someone who can learn, adapt, and roll with a company's mission to change the payer landscape for the better. The Configuration Analyst will conceptualize and drive execution of experiments across service design, operational workflows, and logistics in a way that is iterative, data-driven, and with an eye towards technology-enabled scalability.
As a Configuration Analyst, Senior Associate, you will:
Build processes for making configuration changes from the ground up.
Own the configuration of Clover’s claims engine to drive strategy towards business goals, maximize auto-adjudication and ensure 100% claims processing accuracy.
Lead a small but powerful team of configuration analysts to maintain key configuration data and business logic.
Develop and maintain test cases and a testing framework to ensure accuracy through any configuration changes.
Interpret CMS rules, plan benefits and business objectives to create business rules and claims adjudication logic.
Create formats to structure and store key provider contract information to support claims adjudication needs.
Interface with the claims team to understand challenges 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 (e.g. Navinet for member eligibility).
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 quickly learn and master every aspect of complicated processes and systems.
You are extremely thorough, organized, and detail oriented.
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, major plus if you come with SQL skills.
You should get in touch if:
You have 3+ years of relevant technical experience in software configuration or systems implementation.
You are an experienced team lead or have been a lead analyst within implementations.
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.