Clover Health - Senior Strategic Configuration Analyst
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Requirements
• You possess strong hands-on experience with HealthEdge HRP and Source. • HealthEdge HRP and Source • You are incredibly detail-oriented and have a knack for identifying "edge cases"—those rare but high-dollar scenarios that standard testing might miss. • You have a deep understanding of the end-to-end claim lifecycle and how provider contracts and clinical edits should be technically operationalized in a claims system. • You are passionate about leveraging technology and data-driven insights to drive operational precision. • You have strong verbal and written communication skills with the ability to translate complex technical findings for diverse stakeholders.
Responsibilities
• By the end of your initial 90-day period: You will have mastered the navigation of Clover’s HealthEdge HRP and Source environments and will be actively building and executing test cases that ensure compliance with CMS guidelines and provider contract terms. • By the end of your initial 90-day period: • HealthEdge HRP and Source • By 6 months: You will be the primary lead for configuration testing and validation, utilizing AI tools like Claude, Gemini, and ChatGPT to generate complex testing scenarios and document logic flows to increase the speed and depth of our validation cycles. • Claude, Gemini, and ChatGPT • Continued success: You will serve as the ultimate technical safeguard for Clover’s first-pass accuracy, ensuring that strategic configuration updates result in a measurable reduction in retrospective claim adjustments while maintaining a high-precision payment ecosystem. • Continued success: • You should get in touch if: • You have 5+ years of experience in Medicare Advantage or healthcare plan configuration, testing, or technical quality assurance.
Benefits
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities • Reimbursement for office setup expenses • Monthly cell phone & internet stipend • Remote-first culture, enabling collaboration with global teams • Paid parental leave for all new parents • 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.
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