Senior Manager, Strategic Configuration

Role Description

We are looking for a strategist and technical Senior Manager of Strategic Configuration to lead the evolution of our first-pass claim payment accuracy. This role is a highly specialized, strategic position focused on ensuring claims are paid correctly and precisely the first time.

• First-Pass Accuracy Architecture: Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication. Ensure that complex member benefits and provider contract terms are perfectly synchronized with our accuracy goals.
• Strategic Process Optimization: Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers to ensure payment precision at the point of initial intake.
• Evolution of Automated Solutions: Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration. Utilize data-forward strategies to analyze configuration data, identify trends, and proactively mitigate payment inaccuracies.
• Cross-Functional Synergy: Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance. Ensure that plan designs and regulatory requirements are translated into actionable, high-precision configuration logic.
• Lean Team Leadership: Provide hands-on, "player-coach" leadership for a small, high-impact team of specialists, fostering a culture of excellence, accountability, and continuous technical learning.
• Technical Documentation: Develop best practices and documentation for advanced configuration procedures.

Success in this role looks like:

• By the end of your initial 90-day period: Conduct a deep-dive assessment of our first-pass accuracy landscape, identifying key configuration gaps in current process flows and specifically targeting opportunities for edit optimization to reduce payment variances.
• By 6 months: Implement strategic process flows and enhanced precision-based review triggers that align configuration with payment integrity and clinical review requirements. Establish a refined "accuracy-by-design" workflow that ensures claims are adjudicated correctly during the initial pass.
• Continued success: Lead Clover toward a market-leading first-pass payment accuracy rate by championing automated solutions and predictive modeling.

Qualifications

• 7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role.
• "In the weeds" expertise in technical configuration, specifically regarding complex provider contracts, clinical edits, and general reimbursement logic.
• Highly proficient in health plan systems such as HealthEdge HRP and Source.
• Strong project management and problem-solving abilities with a proven track record of driving systemic process improvements.
• Passionate about leveraging technology and data-driven insights to drive operational precision.
• Excellent verbal and written communication skills with the ability to translate complex technical concepts for diverse stakeholders.

Benefits

• Financial Well-Being: Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews.
• Physical Well-Being: Comprehensive medical, dental, and vision coverage.
• Mental Well-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy.
• Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
• Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, paid parental leave for all new parents.