Senior Strategic Configuration Analyst

At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care. As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives. We are passionate about making healthcare easier, more affordable, and more accessible for everyone.

We are looking for a highly analytical Senior Strategic Configuration Analyst to join our team. Reporting to the Senior Manager, Strategic Configuration, you will be a vital part of a lean, high-impact team dedicated to maximizing first-pass claim payment accuracy.

Your focus is the technical validation and rigorous testing of configuration logic. While the Senior Manager identifies strategy and logic gaps, you are the technical specialist responsible for ensuring that refined edit logic and precision-based review triggers are functioning perfectly before they impact the adjudication cycle. This is a role for a dedicated professional who thrives in the technical details of testing, excels at finding logic flaws through simulation, and is passionate about ensuring that provider contracts and clinical intents are executed with high precision.

• Testing Framework Design & Execution: Architect and execute comprehensive test plans to validate that member benefits, provider contract terms, and general edits—including LCD, NCD, and NCCI coding edits—are configured accurately within our systems.
• Scenario-Based Modeling: Develop and execute complex, scenario-based testing models that simulate real-world medical encounters to ensure configuration holds up under various coding conditions and modifier applications.
• Defect Impact Analysis: Collaborate with the Senior Manager to provide detailed "failed-test" analysis and comprehensive impact assessments, documenting the financial and operational risk where configuration logic diverged from intended outcomes.
• Environment Management: Manage the technical validation lifecycle across testing and UAT environments to ensure "zero-defect" deployments into the live production environment.
• Root Cause Testing: When payment variances are identified, you will simulate those scenarios in a test environment to confirm the root cause and validate that the proposed configuration fix works as intended.
• AI-Enabled Testing: Support the evolution of our testing frameworks by utilizing LLMs to create test scenarios, summarize configuration requirements, and identify edge cases in complex reimbursement logic.
• Cross-Functional Collaboration: Work closely with the core Configuration, Payment Integrity, and internal stakeholders to move logic from testing to production with high confidence.
• Technical Documentation: Maintain detailed records of test results, training materials, and configuration procedures to ensure transparency and compliance with CMS regulations.

• By the end of your initial 90-day period: You will have mastered the navigation of Clover’s HealthEdge HRP and Source environments and will be actively building and executing test cases that ensure compliance with CMS guidelines and provider contract terms.
• By 6 months: You will be the primary lead for configuration testing and validation, utilizing AI tools like Claude, Gemini, and ChatGPT to generate complex testing scenarios and document logic flows to increase the speed and depth of our validation cycles.
• Continued success: You will serve as the ultimate technical safeguard for Clover’s first-pass accuracy, ensuring that strategic configuration updates result in a measurable reduction in retrospective claim adjustments while maintaining a high-precision payment ecosystem.

• You have 5+ years of experience in Medicare Advantage or healthcare plan configuration, testing, or technical quality assurance.
• You possess strong hands-on experience with HealthEdge HRP and Source.
• You are incredibly detail-oriented and have a knack for identifying "edge cases"—those rare but high-dollar scenarios that standard testing might miss.
• You have a deep understanding of the end-to-end claim lifecycle and how provider contracts and clinical edits should be technically operationalized in a claims system.
• You are passionate about leveraging technology and data-driven insights to drive operational precision.
• You have strong verbal and written communication skills with the ability to translate complex technical findings for diverse stakeholders.