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

The Service Operations team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of direct contracting operations. This team maintains the business function of our voluntary alignment & claims activities, including ensuring accuracy & timeliness of processing, maintaining CMS compliance, & resolving escalated issues. The team also works on projects to improve the efficiency & accuracy of cross-functional activities of Service Operations. The success of service operations relies on collaboration with our internal counterparts: Healthcare IT, Provider Data Management, Network, & Customer Experience.

We are looking to hire a Manager of Service Operations for our Direct Contracting line of business to improve the productivity of Clover's voluntary alignment & claims functions through strong organizational skills & operational oversight. In this role you will be responsible for overseeing & maximizing the relationship with our Business Process Outsourcing (BPO) vendor through managing day-to-day interactions, while also ensuring adherence to SLA's & compliance with Clover's internal policies & procedures.

As a Service Operations Manager, Direct Contracting, you will:

  • Develop relationships, own communications, & manage day-to-day interactions with BPO.
  • Guide routine calls with BPO & maximize team efficiency by gathering all updates prior to calls & meetings.
  • Ensure BPO & plan are aligned in terms of expectations, performance & release/delivery timeframes.
  • Partner with leadership & team members to develop audit & oversight plans.
  • Hold BPO and/or internal resources accountable to deadlines, deliverables & remediation plans. Raise concerns or issues to leadership.
  • Research & address issues with BPO. Track & trend incidents, change requests & other tickets across multiple platforms.
  • Review processes & provide recommendations for improvement or remediation of issues.
  • Review vendor performance in comparison with SLAs & CMS requirements. Develop & maintain vendor performance scorecards.
  • Develop & track work plans & assist in establishing operational objectives. Identify appropriate resources to support specific tasks & ensure resources are engaged & performing.
  • Oversee the analysis & remediation of encounter rejections & fallout.
  • Perform other tasks as assigned.

You will love this job if:

  • You want to make an impact. You thrive off of helping others, & want your work to make a difference in our members' lives.
  • You are a team player. You enjoy partnering with others, & want to work collaboratively to find new solutions.
  • You are a strong communicator. You have strong verbal & written communication skills that foster integrity, knowledge sharing, & progress.
  • You are detail-oriented. You pay attention to the small things, while realising how they fit into the bigger picture.
  • You are motivated to learn. There is no shortage of technical, clinical, & operational skills to learn at Clover.
  • You are curious. You like to do research when you don't know an answer. You ask the hard questions & you don't sweep problems under the rug.

You should get in touch if:

  • You have 2-3 years of vendor/BPO management & oversight experience.
  • You have 3-5 years of Medicare Claims experience.
  • You're a strong communicator with proven experience developing & maintaining professional relationships.
  • You can effectively multitask & are able to decipher reports/dashboards & produce presentations & diagrams.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest & 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 & analytics to empower our clinical staff to intervene & provide personalized care to the people who need it most.

We always put our members first, & our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate & mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clovers inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer & our employees are people with different strengths, experiences & backgrounds, who share a passion for improving people's lives. Diversity not only includes race & gender identity, but also age, disability status, veteran status, sexual orientation, religion & many other parts of ones identity. All of our employees points of view are key to our success, & inclusion is everyone's responsibility.


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