Medicare Advantage Enrollment Senior Associate

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.

The Membership team is dedicated and enthusiastic individuals working at the heart of Medicare Advantage operations. This team maintains the business function of our Enrollment and Billing activities, including ensuring accuracy and timeliness of enrollment applications, maintaining compliance with the Centers for Medicare & Medicaid Services (CMS), researching and resolving escalated issues, and ensuring accurate member data throughout the member's journey with Clover. 

As a Medicare Advantage Enrollment Senior Associate, you will serve as the Subject-Matter Expert (SME) in daily operational and AEP readiness, as well as quality assurance activities. You will improve the productivity of Clover's enrollment function through strong organizational skills and operational oversight of the delegated Business Process as a Service (BPaaS) vendor. Furthermore, you will be responsible for overseeing and maximizing the relationship with our BPaas vendor through driving day-to-day interactions, while also ensuring adherence to Service Level Agreements (SLAs) and compliance with CMS regulations and Clover's internal policies and procedures. 

As Medicare Advantage Enrollment Senior Associate, you will: 

• Work autonomously and be motivated to meet and exceed expectations, by being action oriented and a high level of attention to detail. 
• Understand core objectives when managing change or when issues arise. 
• Develop relationships, own communications, and drive day-to-day interactions with the BPaaS team.
• Actively participate in routine calls with the BPaas and maximize team efficiency by gathering all updates prior to calls and meetings. 
• Ensure BPaaS team and plan are aligned in terms of expectations, performance and release/delivery timeframes. 
• Manage the end-to-end annual readiness activities to include Annual Enrollment Period (AEP) and MA Open Enrollment Period (OEP).
• Partner with team members to develop and execute audit and oversight plans, to include SOX (Sarbanes-Oxley) controls to ensure the accuracy and integrity of data impacting financial reporting and performance. 
• Hold BPaaS and/or internal resources accountable to deadlines, deliverables and remediation plans. Raise concerns or issues to leadership. 
• Research and address issues with the BPaaS. Track and trend incidents, change requests and other tickets across multiple platforms. 
• Analyze processes and provide recommendations for improvement or remediation of issues. 
• Analyze vendor performance in comparison with SLAs and CMS requirements. Develop and maintain vendor performance dashboards. 
• 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. 

Success in this role looks like:

• By the end of your 90-day period, you will be responsible for ensuring the accuracy and compliance of the monthly SOX control processes. You will also take ownership of managing cross-functional escalations related to Enrollment and Billing. Additionally, you will independently maintain key KPIs, SLAs, and Compliance dashboards.
• By the 6-months, you will be accountable for validating and ensuring the accuracy of Medicare reporting, while also ensuring timely submissions. You will serve as the subject-matter expert for enrollment application processing, overseeing the development and execution of audits across the end-to-end process. Additionally, you will manage the tracking and delivery of Annual Enrollment Period (AEP) projects to ensure successful and compliant execution.
• Future success in this role will be measured by your ability to develop and execute monthly, quarterly, and annual monitoring and auditing of all critical enrollment functions performed by the BPaaS team, ensuring compliance with Medicare’s stringent rules and regulations and safeguarding member access to care. You will map key internal and BPaaS end-to-end workflows, identifying and recommending improvements. Additionally, you will oversee daily operations and provide departmental and cross-functional support.

You should get in touch if: 

• You have 3–5 years of Medicare Advantage enrollment and billing experience. 
• You have a thorough understand