Senior Director, HEDIS Operations

Clover Health

86d • $176,000 - $200,000

About The Position

At Clover Health, we are dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. Initially scaled within our own Medicare Advantage provider network, we have built an innovative technology platform, designed to put actionable clinical insights into the hands of physicians at the point of care. In 2024, Clover’s PPO plan achieved an industry leading 4.94 stars in HEDIS, with significant impact driven by its innovative technology - Counterpart Assistant. As the Senior Director of HEDIS Operations, you will own and run Clover Health’s HEDIS abstraction processes, ensuring our organization sustains and extends its industry-leading HEDIS and Stars performance. You will be directly responsible for achieving outcomes in Measurement Year 2025 and beyond, bringing unmatched expertise in abstraction, audit readiness, and numerator/exclusion management. You will work across technical, analytical, and clinical teams to operationalize HEDIS results and deliver measurable impact.

Requirements

• 10+ years of experience leading HEDIS or Stars operations for a Medicare Advantage plan or vendor.
• Deep expertise in HEDIS abstraction processes, NCQA specifications, CMS Stars methodology, and audit practices.
• Successfully managed hybrid and prospective review models at scale.
• Known for achieving high HEDIS and Stars performance and can point to direct impact on outcomes.
• Thrive in high-stakes, outcomes-driven environments and can step in quickly to deliver results.

Responsibilities

• Lead and oversee Clover Health’s HEDIS abstraction and submission processes, ensuring timely and accurate execution.
• Manage a team of abstraction experts.
• Partner with analytics and technical teams to ensure data quality supports numerator capture, exclusions, and supplemental data submission.
• Serve as the company’s subject matter expert for HEDIS specifications, auditor engagement, and measure interpretation.
• Develop and refine processes to maximize numerator hits, manage exclusions, and ensure correct denominator definitions for all measures.
• Ensure operational readiness for HEDIS audits, including preparation, submission accuracy, and remediation processes.
• Collaborate cross-functionally with clinical and operational leaders to close gaps and translate abstraction into improved Stars performance.
• Drive daily accountability to outcomes, ensuring abstracted results translate into measurable gains in HEDIS and Stars.

Benefits

• Competitive base salary and equity opportunities.
• Performance-based bonus program.
• 401k matching.
• Comprehensive medical, dental, and vision coverage.
• Mental health resources and flexible time-off policy.
• Learning programs, mentorship, and professional development funding.
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities.
• Reimbursement for office setup expenses.
• Monthly cell phone & internet stipend.
• Paid parental leave for all new parents.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 501-1,000 employees