Senior Strategic Configuration Analyst

🕒 Maio 16

🏄 California – Remoto

🏄 California – Remote

💵 $107.000 - $130.000 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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Clover Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

A Clover Health (Nasdaq: CLOV) é uma empresa de capacitação de médicos focada em idosos que historicamente tiveram dificuldade de acesso a um sistema de saúde de alta qualidade e a preços acessíveis. Nosso objetivo é oferecer um atendimento excelente, de forma sustentável, com um modelo de negócios voltado para melhorar os resultados médicos, reduzindo custos evitáveis. Fazemos isso adotando uma abordagem holística para entender as necessidades de saúde e os fatores de risco social dos que estão sob nosso cuidado. Essa estratégia é sustentada pela nossa plataforma de software proprietária, o Clover Assistant, projetada para agregar dados de pacientes de todo o ecossistema de saúde para apoiar a tomada de decisões clínicas, apresentando aos médicos e outros prestadores recomendações personalizadas em tempo real no ponto de atendimento. Tornar o atendimento mais acessível está no coração do nosso negócio, e acreditamos que os pacientes devem ter a liberdade de escolher seus médicos. Oferecemos planos acessíveis do Medicare Advantage com amplos benefícios, fornecemos aos médicos de atenção primária o Clover Assistant e também disponibilizamos um atendimento abrangente em casa através do programa Clover Home Care. Com a nossa sede corporativa em Nashville, a força de trabalho da Clover está distribuída por todo os EUA e também inclui uma equipe de tecnólogos de classe mundial sediada em Hong Kong. Gerenciamos o cuidado para membros do Medicare Advantage no Alabama, Arizona, Geórgia, Mississippi, Nova Jersey, Pensilvânia, Carolina do Sul, Tennessee e Texas. Estamos contratando engenheiros de software, cientistas de dados, designers e profissionais de produto que possam nos ajudar a entender o bem-estar dos nossos membros e mantê-los longe de quaisquer riscos de saúde no futuro. Se você é uma pessoa apaixonada e interessada em mudar o sistema de saúde para melhor, então a Clover Health pode ser o lugar certo para você.

Descrição

• Architect and execute comprehensive test plans to validate that member benefits, provider contract terms, and general edits—including LCD, NCD, and NCCI coding edits—are configured accurately within our systems. • Develop and execute complex, scenario-based testing models that simulate real-world medical encounters to ensure configuration holds up under various coding conditions and modifier applications. • Collaborate with the Senior Manager to provide detailed "failed-test" analysis and comprehensive impact assessments, documenting the financial and operational risk where configuration logic diverged from intended outcomes. • Manage the technical validation lifecycle across testing and UAT environments to ensure "zero-defect" deployments into the live production environment. • Simulate scenarios in a test environment to confirm the root cause of payment variances and validate that proposed configuration fixes work as intended. • Support the evolution of our testing frameworks by utilizing LLMs to create test scenarios, summarize configuration requirements, and identify edge cases in complex reimbursement logic. • Work closely with the core Configuration, Payment Integrity, and internal stakeholders to move logic from testing to production with high confidence. • Maintain detailed records of test results, training materials, and configuration procedures to ensure transparency and compliance with CMS regulations.

🎯 Requisitos

• 5+ years of experience in Medicare Advantage or healthcare plan configuration, testing, or technical quality assurance. • Strong hands-on experience with HealthEdge HRP and Source. • Incredibly detail-oriented and have a knack for identifying "edge cases"—those rare but high-dollar scenarios that standard testing might miss. • Deep understanding of the end-to-end claim lifecycle and how provider contracts and clinical edits should be technically operationalized in a claims system. • Passionate about leveraging technology and data-driven insights to drive operational precision. • Strong verbal and written communication skills with the ability to translate complex technical findings for diverse stakeholders.

🏖️ Benefícios

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. • Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. • Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. • Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. • Additional Perks: 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 • And much more!