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.