Senior Manager, Strategic Configuration

Cloverhealth

Remote, US
Base: $129,000 - $168,000 usd; bonus/equity: perfo...
Remote
7+ years medicare advantage experience
3+ years leadership role
Healthedge hrp and source proficiency
This role serves as a strategic lead to enhance the accuracy of the initial adjudication cycle by optimizing edit logic and implementing precision-based review triggers

Job Summary

  • This role serves as a strategic lead to enhance the accuracy of the initial adjudication cycle by optimizing edit logic and implementing precision-based review triggers.
  • The successful candidate will act as a player-coach leading a lean team to identify configuration gaps and ensure complex member benefits align with payment integrity goals.
  • Clover Health offers a remote-first culture with comprehensive benefits including medical coverage, mental health resources, and equity opportunities through an Employee Stock Purchase Plan.

Matching Summary

This role serves as a strategic lead to enhance the accuracy of the initial adjudication cycle by optimizing edit logic and implementing precision-based review triggers.

Salary

Base: $129,000 - $168,000 USD; Bonus/Equity: Performance-based bonus program and equity opportunities; Benefits: 401k matching, medical/dental/vision, flexible time-off

Skills & Requirements

Must-have

  • 7+ years Medicare Advantage experience
  • 3+ years leadership role
  • HealthEdge HRP and Source proficiency
  • Complex provider contract configuration
  • Clinical edits and reimbursement logic

Nice-to-have

  • Data-driven operational precision
  • Predictive modeling for payments
  • Cross-functional stakeholder collaboration
  • Lean agile team leadership style
  • Advanced process flow implementation

Key Requirements

  • 7+ years in Medicare Advantage or healthcare plan configuration
  • At least 3 years in a leadership or managerial role
  • Proficiency in HealthEdge HRP and Source systems

Work Rights

Not specified

Tailored Resume

Cover Letter