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 Configuration Business Analyst, you will play an active role in executing on directives that will enable Insurance Operations to scale efficiently to meet the demands of the organization. In addition, you will play a primary role in understanding business requirements laid out through various provider contracts, member benefits, claim edits, and other configurable elements. 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 Configuration Business Analyst, you will:
- Analyze Provider contracts, member benefits, claim edits, and other business requirements to enable accurate and consistent configuration within Clover's Claims system.
- Perform accurate interpretation of state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements and translating them into configurable parameters within Clover's Claims system.
- Be able to work independently to resolve configurations problems or issues through data analysis and contract review.
- Test complex claims scenarios and configurations for both provider contracts and member benefits to ensure intended business outcomes are met.
- Gain a detailed understanding of how our claims system functions and provide insight and feedback into where Clover can configure changes and where we need to modify the system code to implement new contracts or benefits.
- 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 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 gnarly problem.
- 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 2-3 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.
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.