Senior Strategic Configuration Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Design and implement thorough test plans to ensure that member benefits, provider contract terms, and general edits—including LCD, NCD, and NCCI coding edits—are accurately configured within our systems.

• Create and execute complex, scenario-driven testing models that mimic real-world medical encounters to verify that configurations perform effectively under diverse coding conditions and modifier applications.

• Collaborate with the Senior Manager to deliver detailed analyses of "failed tests" and comprehensive impact assessments, documenting financial and operational risks when configuration logic deviates from intended outcomes.

• Oversee the technical validation lifecycle across testing and UAT environments to guarantee "zero-defect" deployments in the live production environment.

• Replicate scenarios in a test environment to identify the root causes of payment discrepancies and validate that proposed configuration adjustments function as expected.

• Contribute to the advancement of our testing frameworks by using LLMs to generate test scenarios, summarize configuration requirements, and pinpoint edge cases in intricate reimbursement logic.

• Collaborate closely with the core Configuration, Payment Integrity, and internal stakeholders to transition logic from testing to production confidently.

• Keep meticulous records of test results, training materials, and configuration procedures to ensure transparency and compliance with CMS regulations.

⛳️ Requirements

• Over 5 years of experience in Medicare Advantage or healthcare plan configuration, testing, or technical quality assurance.

• Strong practical experience with HealthEdge HRP and Source.

• Highly detail-oriented with a talent for identifying "edge cases"—those uncommon but high-stakes scenarios that standard testing may overlook.

• Profound understanding of the complete claims lifecycle and how provider contracts and clinical edits should be operationalized in a claims system.

• Enthusiastic about utilizing technology and data-driven insights to enhance operational accuracy.

• Excellent verbal and written communication skills, with the ability to convey complex technical findings to diverse stakeholders.

🏝️ Benefits

• Financial Well-Being: We are dedicated to attracting and retaining top talent with a competitive base salary and equity opportunities. Additionally, we provide a performance-based bonus program, 401k matching, and regular compensation reviews to acknowledge and reward outstanding contributions.

• Physical Well-Being: We prioritize the health and well-being of our employees and their families by offering comprehensive medical, dental, and vision coverage. Your health is important to us, and we invest in providing access to quality healthcare.

• Mental Well-Being: We recognize the significance of mental health in promoting productivity and maintaining work-life balance. To support this, we offer initiatives like No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Moreover, we foster a remote-first culture that encourages collaboration and flexibility, enabling our team members to succeed from any location.

• Professional Development: Cultivating internal talent is a priority at Clover. We provide learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

• Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities.

• Reimbursement for office setup expenses.

• Monthly stipend for cell phone and internet.

• Remote-first culture that facilitates collaboration with global teams.

• Paid parental leave for all new parents.

• And much more!