Senior Director, Claims and Membership

Clover Health, San Francisco, CA

Clover is a Medicare Plan done differently.

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

Our Insurance Operations teams are working to design, build and implement systems that help Clover succeed. We believe the key driver of our ability to improve health outcomes for our members and affect change in the healthcare system, will be through their experience with the health plan.

In this role, you’ll work closely with every major stakeholder across Clover to ensure that our growing processes reflect our values, our dedication to Compliance and our commitment to the highest quality data possible. You'll have a direct view into how Clover is serving members, providers and CMS today. You’ll manage a growing team of Claims Operations Leads as they support their teams on the front lines, optimize the service Clover is delivering and execute on strategic opportunities to improve the Clover Insurance Operation overall.

As a Senior Director, you will:

  • Investigate operational gaps within claims processes
  • Identify and re-design inefficient workflows
  • Strategize, implement and execute programs to prevent fraud, waste and abuse
  • Collaborate with key stakeholders and departments across the organization to resolve payment issues
  • Provide feedback to help build product and technology roadmaps
  • Work closely with Engineering, Product, Operations and Finance teams and serve as the primary point of contact for payment integrity
  • Assess emerging claims trends and provide strategies for improved payment and, insightful, detail-oriented reporting on those trends
  • Resolve challenging revenue cycle situations and issues relating to payments and payment integrity
  • Build strong, high functioning teams and processes to support payment accuracy and integrity as part of Clover's growing operation
  • Foster an environment that makes claims transparent and learnable by sharing context widely with the company as well as encouraging confident decision-making on your teams

You will love this job if:

  • You are passionate about solving problems; you can roll your sleeves up, dig into details and mentor your teams to do the same.
  • You are humble; as a manager of people, you are there to support your teams and ensure they are set up for success.
  • You are tech and data forward; you’re used to thinking about how technology can enable better operational delivery and how you can use data to make better decisions.
  • You are collaborative; you recognize it takes a village to build and maintain a successful insurance operation
  • You can distill the needs of your customers and team members down to actionable improvements that can be made in Clover's product or procedures. And, you can do all of it while keeping Clover compliant and fiercely protecting the privacy and rights of our customers.

You should get in touch with us if:

  • You have three plus years of medical claims processing and adjustment experience
  • You have experience with CMS rules and regulations in coding and billing compliance
  • You understand outpatient billing or charge captures, chart reviews and coding, payers and reimbursement
  • You have strong verbal, written and interpersonal communication skills
  • You have experience managing high functioning, tech-forward teams
  • You have experience with Third Party Administrators
  • You are a strong verbal and written communicator

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.

About Clover Health

Clover Health is a data driven health insurance startup driving to improve the overall state of healthcare in America. We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road. Unlike other health insurance companies also embracing preventive health, Clover’s Medicare is built on technology from the ground-up. Integrating our systems with doctors, clinicians, and nurse practitioners, Clover’s data team helps healthcare professionals in the field intervene directly into patients’ wellness to help them avoid acute health episodes. If you’re a passionate person and interested in changing healthcare for the better, then Clover may just be the place for you.

Clover Health

Want to learn more about Clover Health? Visit Clover Health's website.