Application Configuration Manager

Location: San Francisco, CA
Job title: Application Configuration Manager
Location: San Francisco, CA
Direct hire
This growing organization is reinventing health insurance through innovative business models, data and analytics to provide personalized care. Join a mission-driven team working together to provide solutions in the complex area of healthcare.
The Insurance Operations team is working to implement systems that help drive healthy outcomes.The Configuration team for Insurance Operations maintains the business function of the insurance application, which is core to the operation of the business. This includes working with the operations teams to understand their day to day needs, resolving escalated issues, and configuring the system. The team also works on projects to improve the efficiency and accuracy of all insurance operations. The team interacts with Membership, Utilization Management, Appeals, Customer Service, and Provider Data groups.
Job description
This position is a Senior Configuration Analyst, or Manager, with responsibilities including developing, managing, and scaling a team within Insurance Operations.
-Provide Systems analysis and configuration, monitoring, audit preparation, and quality accuracy for the mission critical enterprise insurance system.
-Conceptualize and drive execution of new ideas across service design, operational workflows, and logistics in a way that is iterative, data-driven, and with an eye towards technology-enabled scalability.
-Build processes for making configuration changes from the ground up.
-Own the configuration of the claims system to drive strategy towards business goals, maximize auto-adjudication and ensure 100% claims processing accuracy.
-Lead a team of configuration analysts to maintain key configuration data and business logic.
-Develop and maintain test cases and a testing framework to ensure accuracy through any configuration changes.
 -Interpret CMS rules, plan benefits and business objectives to create business rules and claims adjudication logic.
-Create formats to structure and store key provider contract information to support claims adjudication needs.
-Interface with the claims team to understand challenges and proactively drive changes that will increase team efficiency and accuracy.
-Collaborate with Product Managers to develop and maintain key integrations between and across Clover insurance systems.
-Develop and maintain other related adjudication and eligibility configurations (e.g. Navinet for member eligibility).
-Support the organization with escalation support for claims-related inquiries with a root cause in configuration.
-Ensure compliance with all CMS claims regulations.
Experience & Skills
-Strong experience in health insurance system implementations and interest in striving to implement improvements to the insurance and payer process.
-Relevant technical experience in software configuration or systems implementation.
-Experienced manager or team lead on software and process implementations.
-Ability to learn and master complicated processes and systems.
-Thorough, organized, and detail oriented.
-Problem solver who enjoys solving complex problems.
-Experience with data and using it to make metric-driven decisions, some hands on experience with SQL is highly useful

Warmest regards,
Aileen Bradley
Addastaff Consulting, Inc.
Senior Technical Recruiter
650-638-9633 x303

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