Senior Manager, Strategic Configuration

Clover Health

1d•$129,000 - $168,000•Remote

About The Position

At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care. As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives. We are passionate about making healthcare easier, more affordable, and more accessible for everyone. We are looking for a strategist and technical Senior Manager of Strategic Configuration to lead the evolution of our first-pass claim payment accuracy. While our core configuration team handles daily "business as usual" workflows, this role is a highly specialized, strategic position focused on ensuring claims are paid correctly and precisely the first time. In this role, you will lead a lean, agile team, acting as the strategic lead for enhancing the accuracy of the initial adjudication cycle. This requires a "player-coach" who can "get in the weeds" of technical configuration—specifically regarding contract logic, clinical edits, and reimbursement rules—while maintaining the strategic mindset needed to drive industry-leading precision. Your mission is to identify and address configuration gaps, refine edit logic, and implement advanced process flows that maximize first-pass accuracy, effectively reducing administrative friction and retrospective adjustments for both members and provider partners.

Requirements

7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role.
"In the weeds" expertise in technical configuration, specifically regarding complex provider contracts, clinical edits, and general reimbursement logic.
Highly proficient in health plan systems such as HealthEdge HRP and Source.
Strong project management and problem-solving abilities with a proven track record of driving systemic process improvements.
Passionate about leveraging technology and data-driven insights to drive operational precision.
Excellent verbal and written communication skills with the ability to translate complex technical concepts for diverse stakeholders.

Responsibilities

Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication.
Ensure that complex member benefits and provider contract terms are perfectly synchronized with our accuracy goals.
Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers to ensure payment precision at the point of initial intake.
Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration.
Utilize data-forward strategies to analyze configuration data, identify trends, and proactively mitigate payment inaccuracies.
Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance.
Ensure that plan designs and regulatory requirements are translated into actionable, high-precision configuration logic.
Provide hands-on, "player-coach" leadership for a small, high-impact team of specialists, fostering a culture of excellence, accountability, and continuous technical learning.
Develop best practices and documentation for advanced configuration procedures.