Job Description
The Membership team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of service operations. This team maintains the business function of our mailroom, enrollment and premium billing activities, including ensuring accuracy and timeliness of enrollment applications, maintaining 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 a Manager of Service Operations to improve the productivity of Clover’s enrollment and mailroom function through strong organizational skills and operational oversight.
In this role you will be responsible for overseeing and maximizing the relationship with our Business Process as a service (BPaas) vendor through managing day-to-day interactions, while also ensuring adherence to SLA’s and compliance with Clover’s internal policies and procedures.
As a Manager of Service Operations, you will:
- Manage all Enrollment and Billing operations effectively, efficiently and compliantly to ensure that applicant and member information is processed accurately, appropriately and timely.
- Ensure members are billed accurately and timely for monthly premiums and/or Late Enrollment Penalties and that any external subsidies (Low Income or SPAP) are applied accurately and timely so members pay only their liability.
- Directs and oversees incoming mailroom activities including the scanning, sorting and routing of incoming mail to the appropriate business units.
- Be the point of contact for regulatory requirements to include Medicare Program Audits, One Third Financial Audits, Quarterly CMS Attestations and implementation of new or revised guidance.
- Ensure organizational policies are developed and maintained within Clover and the BPaas organization and ensure accountability.
- Work cross functionally in support of ensuring applicants and members have the best experience possible.
- Problem solve complex issues and drive to resolution.
- Develop relationships, own communications, and manage day-to-day interactions with BPaas.
- Guide routine calls with BPaas and maximize team efficiency by gathering all updates prior to calls and meetings.
- Ensure BPaas 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 BPaas. Track and trend incidents, change requests and other tickets across multiple platforms.
- Review processes and provide recommendations for improvement or remediation of issues.
- Review vendor performance in comparison with SLAs and CMS requirements. Develop and maintain vendor performance scorecards.
- 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 tasks as assigned.
You should get in touch if:
- You have 3+ years of vendor/BPaas management and oversight experience.
- You have 5+ years of Medicare mailroom or enrollment and billing experience.
- You are 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.
Benefits Overview:
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer 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 cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
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 people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.
#LI-REMOTE
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.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
A reasonable estimate of the base salary range for this role is:
$129,200—$168,000 USD
