Clover is reinventing health insurance by working to keep people healthier.
The Configuration team is a group of hard-working, dedicated analysts at the heart of Insurance Operations. This team maintains the business function of our insurance system activities, including working with the operations teams (Claims, Enrollment, Network Management, etc.) 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 Senior Configuration Analyst, you will play an active role in executing on a strategy that will enable Insurance Operations to scale efficiently to meet the demands of the organization. In addition, you will play a primary role in developing and executing test scenarios for provider, benefit and pricing configuration. We are looking for a candidate with experience in health system implementations, operational configuration management (provider contract, claims and benefits), and has a strong conviction that health insurance can and should be better.
As a Senior Configuration Analyst, you will:
- Assist in the preparation and execution of Quality Assurance (QA) reviews and the development of test plans and test scripts.
- Partner with Clover's claims as well as configuration business analysts in testings of modified/new system configurations.
- Participate in the analysis and development of new or revised QA testing procedures and processes.
- Provide internal support to Clover staff in resolving process and procedure questions and required documentation.
- Help lead the review of QA procedures and processes and the development of QA metrics that will serve as the baseline for for assessing the quality delivered application software or systems.
- Work with your team to help ensure Clover compliance with all CMS claims regulations.
You will love this job if:
- You are a great communicator and able to communicate across different teams and upward to senior leadership. .
- You are a strategic prioritizer, and able to identify where and when to focus your energy.
- You are a problem solver and like getting your hands dirty with the details of a complex problems.
- You love data and using it to make metric-driven decisions.
- You are passionate about healthcare and opportunities for improving the lives of insurance members.
You should get in touch if:
- You have 3-5 years of relevant technical experience in health insurance software configuration or systems implementation.
- You are an experienced team lead or have been a lead analyst within implementations.
- You have experience working in provider, benefits and/or claims configurations.
- You have a working knowledge of provider contracts and Medicare claim payment methodologies.
- You have proven experience working with analytical tools. Major plus if you come with SQL skills.
- You have Medicare or Medicaid experience (preferred, not required).
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.
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
Clover Health welcomes qualified candidates with disabilities and will provide accommodations during the interview process as needed. If you require accommodations, please email with the details of your requested accommodation. Requests are reviewed by a member of the recruiting team. Requests will have no bearing on the candidate evaluation process or hiring decisions.