Senior Manager, Service Operations

About the role

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.

Responsibilities

• 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.
• Direct and oversee 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.
• Solve complex issues and drive to resolution.
• Develop relationships, own communications, and manage day-to-day interactions with BPaas.
• 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.

Requirements

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.

Qualifications

Additional qualifications include:

• Strong organizational skills and operational oversight.
• Experience with regulatory requirements and compliance.
• Ability to work cross-functionally and collaborate with internal teams.
• Effective communication and relationship-building skills.
• Proven ability to solve complex issues and drive to resolution.
• Experience with vendor management and oversight.
• Experience with Medicare mailroom or enrollment and billing operations.
• Ability to manage multiple tasks and deliverables simultaneously.
• Experience with process review and improvement.
• Experience with vendor performance monitoring and reporting.
• Experience with project management and work planning.
• Ability to identify and engage appropriate resources for specific tasks.
• Ability to research and address issues with vendors.
• Experience with tracking and trending incidents, change requests, and other tickets across multiple platforms.
• Experience with reviewing and providing recommendations for process improvements or remediation of issues.
• Experience with reviewing vendor performance in comparison with SLAs and CMS requirements.
• Experience with developing and maintaining vendor performance scorecards.
• Experience with developing and tracking work plans and establishing operational objectives.
• Ability to identify appropriate resources to support specific tasks and ensure resources are engaged and performing.
• Ability to perform other tasks as assigned.

Skills

Skills required for this role include:

• Vendor/BPaas management and oversight.
• Medicare mailroom or enrollment and billing experience.
• Strong organizational and operational oversight skills.
• Regulatory compliance and requirement management.
• Collaboration and cross-functional teamwork.
• Effective communication and relationship-building.
• Problem-solving and issue resolution.
• Process review and improvement.
• Vendor performance monitoring and reporting.
• Project management and work planning.
• Resource identification and engagement.
• Issue research and addressing.
• Incident, change request, and ticket tracking.
• Process review and improvement recommendations.
• Vendor performance monitoring and reporting.
• Work plan development and objective establishment.
• Resource identification and engagement.
• Other tasks as assigned.

Benefits

Financial Well-Being: Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews.
Physical Well-Being: Comprehensive medical, dental, and vision coverage.
Mental Well-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy.
Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, paid parental leave for all new parents, and much more!

Pay

A reasonable estimate of the base salary range for this role is: $129,200—$168,000 USD.

Schedule

Not specified.