Senior Manager, Service Operations

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🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $129.2k - $168k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Clover Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

🛡️ Insurance

🤖 Artificial Intelligence

Healthcare • Insurance • Artificial Intelligence

Clover Health is a healthcare technology company helping members live their healthiest lives with our Medicare Advantage plans. Focused on seniors who have historically lacked access to affordable and high-quality healthcare, Clover aims to provide care sustainably by improving medical outcomes while simultaneously lowering avoidable costs. They leverage a proprietary software platform, the Clover Assistant, to aggregate patient data and offer real-time recommendations to healthcare providers. Their services include affordable Medicare Advantage plans, a home care program, and they manage care for Medicare Advantage members across several U. S. states.

📋 Description

• Manage all Enrollment and Billing operations effectively, efficiently and compliantly to ensure that applicant and member information is processed accurately, appropriately and timely. • Ensure members are billed accurately and timely for monthly premiums and/or Late Enrollment Penalties and that any external subsidies (Low Income or SPAP) are applied accurately and timely so members pay only their liability. • Directs and oversees incoming mailroom activities including the scanning, sorting and routing of incoming mail to the appropriate business units. • Be the point of contact for regulatory requirements to include Medicare Program Audits, One Third Financial Audits, Quarterly CMS Attestations and implementation of new or revised guidance. • Ensure organizational policies are developed and maintained within Clover and the BPaas organization and ensure accountability. • Work cross functionally in support of ensuring applicants and members have the best experience possible. • Problem solve complex issues and drive to resolution. • Develop relationships, own communications, and manage day-to-day interactions with BPaas. • Guide routine calls with BPaas and maximize team efficiency by gathering all updates prior to calls and meetings. • Ensure BPaas and plan are aligned in terms of expectations, performance and release/delivery timeframes. • Partner with leadership and team members to develop audit and oversight plans. • Hold BPaas and/or internal resources accountable to deadlines, deliverables and remediation plans. Raise concerns or issues to leadership. • Research and address issues with BPaas. Track and trend incidents, change requests and other tickets across multiple platforms. • Review processes and provide recommendations for improvement or remediation of issues. • Review vendor performance in comparison with SLAs and CMS requirements. Develop and maintain vendor performance scorecards. • Develop and track work plans and assist in establishing operational objectives. Identify appropriate resources to support specific tasks and ensure resources are engaged and performing. • Perform other tasks as assigned.

🎯 Requirements

• You have 3+ years of vendor/BPaas management and oversight experience. • You have 5+ years of Medicare mailroom or enrollment and billing experience. • You are a strong communicator with proven experience developing and maintaining professional relationships. • You can effectively multitask and are able to decipher reports/dashboards and produce presentations and diagrams.

🏖️ Benefits

• 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.