Enrollment QA Specialist

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

The Membership team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of insurance operations. This team maintains the business function of our enrollment and premium billing activities, including ensuring accuracy and timeliness of enrollment applications, maintaining the Centers for Medicare & Medicaid Services (CMS) compliance, resolving escalated issues, and ensuring accurate member data throughout the member's journey with Clover. The team also works on projects to improve the efficiency and accuracy of cross-functional activities of Insurance Operations. The success of insurance operations relies on collaboration with our internal counterparts: Claims, Utilization Management, Appeals, Grievances, and Customer Experience.

We are looking to hire an Enrollment QA Specialist to 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. In this role 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 a Enrollment QA Specialist, in conjunction with the Senior Manager, Service Operations, you will:

• Develop relationships, own communications, and drive day-to-day interactions with the BPaaS.
• Lead 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.
• 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 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.
• Perform other duties as assigned.

You will love this job if:

• You want to make an impact. You thrive off of helping others, and want your work to make a difference in our members' lives.
• You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.
• You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.
• You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.
• You are motivated to learn. There is no shortage of technical, clinical, and 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 and you don't sweep problems under the rug.

You should get in touch if:

• You have 3-5 years of vendor/BPO (Business Process Outsourcing) or BPaaS management and oversight experience.
• You have 2-3 years of Medicare enrollment and billing experience.
• You're 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.

 

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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and 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 and analytics to empower our clinical staff to intervene and provide personalized care to the peo