Configuration Provider and Contract Specialist at Clover Health
San Francisco, CA, US

Clover is reinventing health insurance by working to keep people healthier.

The Configuration team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of insurance operations. This team maintains the business function of our insurance system activities, including working with the operations teams to understand their day to day needs, escalated issue resolution, and claims system configuration. The team also works on projects to improve the efficiency and accuracy of all of Insurance Operations. The success of insurance operations relies on collaboration with our internal counterparts: Membership, Utilization Management, Appeals, Grievances, Customer Service, and Provider Data.

As a Configuration Provider and Contract Specialist at Clover you will play an active role in ensuring Clover's provider structure and contracts are accurately set-up and monitored. You will collaborate cross-functionally with the Benefits, Claims, and Operations Analytics teams to work on quality accuracy, audit preparation, and software optimization. We are looking for a candidate with provider contract experience and who has a strong conviction that health insurance can and should be better.

As a Configuration Provider and Contract Specialist, you will:

  • Learn and execute Clover policies and procedures for accurate provider and pricing configuration and monitoring.
  • Actively document new configuration processes, as well as improve on current processes.
  • Work closely with team leads and operational owners to interpret CMS rules, contract terminology, and business objectives to create business rules and claims adjudication logic.
  • Interface with operational teams to understand challenges and proactively drive changes that will increase team efficiency and accuracy.
  • Support the entire Clover organization with escalation support for provider-related inquiries with a root cause in configuration.
  • Ensure Clover compliance with all CMS claims regulations via system configurations.

You will love this job if:

  • You are a quick learner and master every aspect of complicated processes and systems.
  • You are extremely thorough, organized, and detail oriented.
  • You are a problem solver and enjoy getting your hands dirty with the details of a gnarly problem.
  • You love data and using data to make metric-driven decisions, major plus if you come with SQL skills.
  • You are a do-er! Ideas are great, but output is essential!

You should get in touch if:

  • You have meticulous attention to detail and are a quick learner of systems.
  • You can manage independent workstreams, and enjoy mentoring and training team members.
  • You have 3 or more years of experience in healthcare, specifically within insurance operations claims, configuration or implementations: including understanding CPT, HCPCs and ICD-CM Codes, experience with claims software HealthRules or Facets, and knowledge of claim coding.

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.