Aug 13, 2019
Clover Health Clover is reinventing health insurance by working to keep people healthier. The Configuration team is a group of hard-working, dedicated analysts working 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, Utilization , finance etc.) to understand their day to day needs, resolving escalated issues, and configuring our systems. 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, Finance, Claims and Provider Data. As a Healthcare Technology Manager at Clover you will play an active role in developing, managing, and scaling a team which includes systems analysis and configuration, monitoring, audit preparation, and quality accuracy. You will conceptualize and drive execution of experiments across service design, operational workflows, and logistics in a way that is iterative, data-driven, and with an eye towards technology-enabled scalability. We are looking for someone with strong experience in health system implementations, leading teams to high quality outcomes, and has a strong conviction that health insurance can and should be better. You should have a good understanding of informational systems and healthcare data inputs (e.g., member, provider, claims and clinical data) as well as healthcare operations experience. You will report to the Director of IT and continuously partner with key management staff to extract business requirements and turn them into solutions that can be carried out by the Clover Health team. As a Healthcare Technology Manager Manager, you will: Be responsible for tracking and optimizing Clover's claims, provider, encounters, finance, utilization, customer service and membership systems. Guide a team in building configuration processes from the ground up, including designing key configuration data and business logic. Collaborate with others in IT and operational departments to design, assist and configure for implementations, improvements, and where appropriate, automation. Work with key staff throughout the organization and with outside business partners to ensure Clover's systems are configured properly. Liaison between our business partners and IT while meeting priorities driven by operations implementations, system configuration, improvements, open enrollment, CMS requirements etc. Drive strategy of Clover's claims system towards business goals: maximizing auto-adjudication and ensuring 100% claims processing accuracy. Develop and maintain test cases and a testing framework to ensure accuracy through any configuration changes. Interface across broader Operations teams to understand and prioritize improvement areas, and proactively drive changes that will increase team efficiency and accuracy. Collaborate with Product Managers to develop and maintain key integrations between and across Clover insurance systems. Develop and maintain other related adjudication and eligibility configurations (e.g., Navinet for member eligibility). 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. Support forthcoming projects working directly with Operations, IT and the configuration team. Develop strategies to simplify and improve configuration to be more efficient and streamlined. Develop release strategies for CMS releases, system upgrade releases, fee schedule and base code set releases. You will love this job if: You are a great communicator and able to communicate across different teams and upward to management. 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, major plus if you come with SQL skills. You are creative and able to think of unique ways to handle challenges and to improve processes. You are organized and detail orientated person. You are a thoughtful leader and enjoy facilitating meetings and presenting to diverse teams. You should get in touch if: You have 10+ years of relevant technical experience in 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, members, benefits, pricing and/or claims configurations. You are passionate about healthcare and opportunities for improving the lives of insurance members.
Professional Diversity Network Nashville, TN, USA Full-Time