Clover Health

Business Analyst

• Deliver timely daily and weekly operational reports to track case volumes, timeliness, and performance against KPIs.
• Validate A&G case inventory for accuracy, completeness, and compliance with CMS requirements.
• Analyze operational data to identify trends, root causes, and opportunities for process improvement.
• Collaborate with Operations, Compliance, and IT to implement workflow enhancements and regulatory updates.
• Support the development and integration of CMS and organizational guidance into operational systems.
• Partner with the Quality and STARS teams to monitor decision-making metrics and drive performance improvements.
• Prepare for audits by ensuring reporting and documentation are accurate, comprehensive, and audit-ready.
• Provide data-driven insights to cross-functional partners and governance committees to enhance member experience.

Business Analyst – Appeals & Grievances

Medical Director

• Define and direct the strategic roadmap for all Utilization Management activities, ensuring clinical excellence, regulatory compliance, and alignment with Clover Health’s overall commitment to member health outcomes.
• Provide executive oversight and mentorship to the Utilization Management team, including Medical Directors and UM nurses, fostering their clinical development and strengthening the effectiveness of the entire UM function.
• Spearhead the ongoing development and implementation of Clover Health’s clinical guidelines, ensuring they incorporate current national standards (such as Milliman Care Guidelines, Interqual Criteria, and CMS Determinations) to consistently facilitate high-quality, medically appropriate care.
• Act as a senior clinical liaison, engaging in high-level peer-to-peer discussions with network primary care physicians and specialists to resolve complex service requests and ensure seamless continuity of care for our members.
• Lead operational excellence by evaluating utilization trends, developing educational resources for providers, and streamlining the UM, Grievance, and Appeals processes to reduce friction and improve transparency for physicians.
• Drive quality improvement initiatives by partnering closely with Clover Health's Medical Management Committee to review the utilization process and ensure all decisions adhere to accepted standards for medical necessity.

Associate Chief Medical Officer, Medicare Advantage

Business Operations

• Lead financial and operational planning for Clover Care Services, including cost center oversight, budgeting, forecasting, and alignment of spend with visit volumes and growth goals.
• In partnership with the Chief Operating Officer, manage vendor relationships and contracting, ensuring efficiency, compliance, and alignment with operational and financial objectives.
• Oversee call center and scheduling operations performance for CCV operations (staffing levels, capacity, reach rates, scheduling utilization, productivity metrics) to optimize patient access and team efficiency.
• Drive productivity and logistics management for clinical and administrative support functions, including visit volume tracking, staffing models, and capacity planning.
• Support revenue cycle management by ensuring accurate and timely billing, claims processing, denial management, and issue resolution in partnership with Finance and Compliance.
• Lead EHR systems oversight, including provider education, configuration management, and issue escalation to ensure seamless operational workflows.
• Develop and implement standardized workflows and procedures that promote consistency, scalability, and operational excellence across care delivery support teams.
• Partner in modeling and forecasting, developing data-driven projections for visits, enrollment, and staffing to guide strategic decision-making.
• Collaborate cross-functionally with clinical and business leaders to align operational performance with quality, cost, and patient/member experience goals.
• Monitor operational performance metrics and lead continuous improvement initiatives to increase efficiency and reduce cost per visit.
• Ensure financial stewardship, including invoice review, spend tracking, and cost management for all CCS vendors and contractors.
• Support OKR development and management, ensuring key performance indicators are aligned with organizational strategy and regularly reported.

Director, Clinical Business Operations

Marketing

• Develop high-quality content across channels: website, email, social, PR, webinars, and sales collateral.
• Manage Counterpart’s content calendar, ensuring consistency in tone, timing, and storytelling tailored predominantly to provider and health plan audiences.
• Partner with leadership on thought leadership pieces, press releases, and case studies that demonstrate measurable outcomes and clinical impact.
• Support conference and event marketing efforts — from pre-event promotion and on-site materials to post-event follow-up — ensuring a cohesive narrative across channels.
• Ensure consistent application of Counterpart’s brand voice (Human, Innovative, Trustworthy, Engaging).
• Collaborate with design to evolve creative assets, visuals, and messaging frameworks that reflect our expanding platform.
• Support updates to the website and marketing collateral as the product suite expands.
• Partner closely with Product Marketing to coordinate product launches and announcements across channels.
• Create clear, benefits-driven messaging that translates technical and clinical details into audience-specific language for providers and enterprise partners.
• Maintain cross-team visibility on product milestones to ensure proactive alignment and timely marketing execution.
• Oversee supporting materials such as website updates, social posts, and sales enablement content tied to product news.
• Track and report on key marketing indicators (campaign engagement, content performance, inbound interest, sales enablement impact).
• Use insights, not just metrics, to optimize strategy and identify new opportunities for visibility, reputation, and pipeline support.
• Work cross-functionally with Product, Design, and Sales to ensure marketing directly supports business objectives and go-to-market priorities.
• Act as a connector between Marketing and Product, ensuring a shared understanding of goals, timelines, and market narratives.

Senior Manager, Marketing

Infrastructure Engineer

• Design, build, and maintain systems for declarative application and infrastructure lifecycle management, including continuous integration, continuous deployment (CI/CD), Kubernetes cluster management, and service/workload inventory.
• Automate infrastructure provisioning and application deployments using infrastructure-as-code (IaC) tools and deployment patterns.
• Improve deployment processes by automating delivery pipelines, database migrations, and operational tasks.
• Prioritize and troubleshoot system issues, alerts, and downtime with a focus on stability and rapid incident response.
• Implement monitoring and observability solutions to proactively identify and resolve performance bottlenecks.
• Foster a healthy, collaborative, and high-performing engineering culture by working across teams to build reliable, scalable systems.
• Continuously assess and improve the infrastructure to support secure, highly available, and resilient environments.
• Develop and enforce Identity Access Management (IAM) policies to govern authentication and authorization across cloud platforms.

Cloud Infrastructure Engineer

Bilingual

• Initiate outreach to patients and caregivers to explain the benefits of home-based care services—including clinical, emotional, and logistical advantages.
• Leverage bilingual English–Korean fluency to educate patients, answer questions, collect consent, and document interactions in the patient’s preferred language—serving as a language bridge for care teams.
• Build rapport and guide decision-making using motivational interviewing; confidently handle objections and navigate sensitive conversations.
• Manage referrals end-to-end: review inbound referrals, conduct timely proactive outreach to eligible patients, and follow up with undecided patients to maintain momentum.
• Own the enrollment workflow from eligibility verification through paperwork and consent, coordinating with care teams, discharge planners, physicians, and social workers for continuity of care.
• Maintain accurate EMR documentation of outreach, patient concerns, and enrollment status (Athena preferred).

Patient Enrollment Specialist, Korean Bilingual

Product Manager

• Be a leader on a pod with the product ‘triad’: product, design, engineering, and data science. As a healthcare product, we also deeply integrate and coordinate with our clinical teams (MDs, NPs, RNs, MAs, coders, billers, etc.).
• Be the subject matter expert on the pod for all things relating to our user, business, and industry.
• Focus on identifying and solving the highest impact areas both for our users and our business simultaneously.
• Iteratively improve the product, finding ways to deliver customer value as early as possible in the development process.
• Articulate how the pod can measure the progress it’s making; if you can’t measure it, you can’t describe how you’ve moved it.
• Be accountable for the outcomes of the pod, finding solutions to problems and enabling the success of the pod.

Clinical Operations

• Manage the design and execution of high-impact initiatives that advance clinical program performance, such as care coordination pilots, quality improvement efforts, and workflow optimization, including implementation planning, deployment, and ongoing performance tracking of the initiatives.
• Translate strategic goals into actionable project plans with milestones, owners, and measurable outcomes, and owning accountability for successful execution.
• Monitor project progress and ensure alignment with clinical, operational, and business priorities.
• Build and refine operational frameworks, dashboards, and process documentation to enable consistent and efficient execution across teams.
• Develop playbooks and implementation models for repeatable success in clinical operations.
• Partner with cross-functional teams (Clinical, Data, Product, Operations, Compliance) to ensure smooth execution and knowledge sharing.
• Coordinate with external partners and vendors to align systems, timelines, and outcomes.
• Identify inefficiencies, bottlenecks, or gaps in care delivery workflows and drive solutions.
• Gather and analyze performance data to surface insights that inform operational and strategic decisions.
• Establish feedback loops with clinical teams to continuously improve processes and systems.

Special Project Lead – Clinical Operations

Manager

• Oversee Regulatory QI Program Elements: lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan, ensure timely completion of annual QI Program Evaluation, manage QI Committee activities.
• Regulatory Compliance & Audit Readiness: ensure CMS, NCQA, and state QI requirements are met, maintain audit readiness for CMS Program Audits, partner with Legal and Compliance teams.
• Quality of Care Oversight: oversee Quality of Care investigations, collaborate with Medical Directors and clinical teams.
• Performance Monitoring & Improvement: support Star Ratings strategy, present QI outcomes, implement cross-functional improvement initiatives.
• Leadership & Collaboration: supervise QI professionals, lead cross-departmental working groups, foster a culture of quality, compliance, and continuous improvement.

Senior Manager, Quality Improvement

• Own the End-to-End Commission Cycle: Lead the entire monthly commissions operation, from data validation to ensuring our finance team executes payouts on time to working with data partners.
• Drive Strategic Improvements: Go beyond the day-to-day. You’ll proactively oversee key reports, identify, research, and resolve bugs, flagging repetitive errors to leadership and develop new, scalable processes to improve our processes with an eye towards automation.
• Manage Commission Policy & Compliance: Lead the drafting, updating, and maintenance of all formal commission policies, while ensuring strict operational adherence and providing all necessary SOX documentation.
• Serve as the Subject Matter Expert: Master commission tools and payment structures to serve as the go-to resource for resolving partner inquiries, advising internal staff on complex payment issues, and leading educational outreach.
• Lead the Team: Oversee commissions team, fostering a collaborative and growth-oriented culture.

Commissions Manager, Medicare Advantage

Engineering Manager

• Be accountable for the team's impact; guide the team to achieve a high level of technical productivity and reliability.
• Foster a healthy, results-oriented, and collaborative culture that is the bedrock of strong teams.
• Represent the team in engineering organization-wide planning, initiatives, and processes.
• Work with Product Managers and Designers to develop our technical roadmap and our approach to solving problems that improve the experience of patients and doctors.
• Set the direction for your team collaboratively, clearly establishing objectives that are aligned with Clover's company level goals and roadmap.
• Participate in sourcing, screening, hiring, growing, and retaining talent.

• Own the full product lifecycle for technology and operational tools—from discovery and design through development, launch, adoption, and continuous improvement.
• Collaborate deeply across teams (engineering, data science, clinical operations, provider engagement, and analytics) to identify and deliver technology solutions that enable scaling of care delivery.
• Translate clinical and operational needs into actionable product requirements and solutions that are both technically sound and mission-driven.
• Drive implementation and adoption, ensuring products are effectively deployed, supported with the right training and change management, and delivering on their intended outcomes.
• Monitor performance post-launch—using data and feedback to iterate and optimize for clinical, operational, and member impact.
• Develop and track KPIs to measure how each product or tool enhances provider engagement, workflow efficiency, and care outcomes.
• Ensure interoperability and scalability across Clover’s technology ecosystem, building tools that evolve with the organization’s growth and market expansion.
• Champion innovation and accountability, creating systems that empower teams to continuously learn, adapt, and scale their impact.

Clinical Product Manager

Operations

• Lead and oversee Clover Health’s HEDIS abstraction and submission processes, ensuring timely and accurate execution.
• Manage a team of abstraction experts
• Partner with analytics and technical teams to ensure data quality supports numerator capture, exclusions, and supplemental data submission.
• Serve as the company’s subject matter expert for HEDIS specifications, auditor engagement, and measure interpretation.
• Develop and refine processes to maximize numerator hits, manage exclusions, and ensure correct denominator definitions for all measures.
• Ensure operational readiness for HEDIS audits, including preparation, submission accuracy, and remediation processes.
• Collaborate cross-functionally with clinical and operational leaders to close gaps and translate abstraction into improved Stars performance.
• Drive daily accountability to outcomes, ensuring abstracted results translate into measurable gains in HEDIS and Stars.

Senior Director, HEDIS Operations

Software Engineer

• Own coordination and facilitation of key standing forums (Tech Program Review, Post-Mortems, Technical Design Review Board, Engineering Culture Group): agendas, decisions, action tracking, follow-through
• Stand up programs for patents, standards tracking, bug bounty, and open source governance including invention disclosures, IP review, standards registry, bug bounty policy and intake, open source license compliance
• Ensure ongoing certification and compliance (HITRUST, SOC 2, HIPAA): control ownership, evidence collection, audit readiness, corrective action tracking, monitoring calendars
• Partner with Product, Customer, and Engineering leaders to define engineering health dashboards and a common metrics glossary
• Implement end-to-end reporting on DORA metrics, cycle time, defect escape rate, availability/SLOs, on-call health, and cost of service; ensure data quality and single source of truth
• Drive monthly/quarterly reviews to prioritize investments, remove bottlenecks, and improve reliability
• Serve as Engineering DRI for capitalization capture/process, R&D tax credits, and QI-related reporting in partnership with Finance/Tax
• Own engineering vendor lifecycle: selection, contracts, renewals, usage optimization, and Procurement liaison
• Assist with workforce planning: headcount tracking, hiring plan alignment, and budget vs. actuals
• Report on cloud spend; forecast infra/tooling budgets; implement tagging standards, chargebacks/showbacks, anomaly detection, and savings plans/commitments management
• Lead intra-team and cross-functional communications: staff updates, program newsletters, release/incident comms, decision memos, and exec readouts
• Plan and track cross-team initiatives (services↔monolith migrations, infra upgrades, AI adoption): charters, roadmaps, milestones, dependency management, stakeholder mapping, and change-management plans
• Represent SVP of Engineering in key forums; prepare briefing docs, pre-reads, decision frameworks; drive agendas and outcomes for offsites and exec syncs
• Build and mentor a high-performing EngOps/TPM function; define operating model, career ladders, hiring bar, and coaching rhythms
• Foster a culture of learning, psychological safety, and crafted execution; level up TPMs on operational excellence

Director of Engineering Operations

• Manage prospective claim review queues related to clinical DRG coding compliance, readmissions programs, and cross-functional high dollar claim review
• Develop and execute strategies and procedures to grow the payment integrity team and drive process improvements
• Ensure payment integrity programs run smoothly and stay compliant with internal and Medicare guidelines
• Prepare provider responses to clearly and accurately deliver review decisions within regulatory timeframes established by CMS
• Identify potential program efficiencies and implement procedural responses
• Analyze existing policies to ensure accuracy and proper execution
• Collaborate with teams across Clover to ensure provider understanding of Payment Integrity recommendations and support those recommendations when necessary
• Act as Subject Matter Expert to counsel team members on clinical coding guidelines and communicate complex concepts to stakeholders including senior leadership
• Train team members to take on additional responsibilities and help prioritize work functions
• Research and respond to external auditor concerns regarding completeness and accuracy of data creation and integration
• Incorporate cross-functional perspectives and business needs in solving complex problems
• Communicate effectively internally and externally to ensure accurate claims adjudication and proper provider notification
• Oversee prepay clinical review workflows and contribute to DRG validation, avoidable readmission reviews, length-of-stay reviews, and provider appeals as a subject matter expert

Clinical Coding Manager

Technical Recruiter

• Own full-cycle recruiting for a subset of Clover's technology teams
• Partner with hiring managers to understand role scope and business needs and build effective job descriptions, hiring/interview plans and targeted sourcing strategies
• Track, analyze, and share pipeline and performance data with hiring teams and internal recruiting partners
• Facilitate decision making and advise on roadblocks with recommended solutions to deliver top talent
• Develop creative sourcing tactics to actively engage passive candidates and increase pipeline diversity
• Use market intelligence and funnel metrics to inform search strategy and build trusting relationships with leaders and hiring managers
• Serve as the first point of contact with prospective candidates and effectively pitch Clover and the hiring teams

• Evaluate all outpatient referrals and inpatient direct admissions for medical appropriateness
• Utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, and Clover Health medical policies to determine medical necessity or recommend alternate treatment plans
• Participate in and support Clover Health Utilization Management processes
• Support quality improvement initiatives for Clover members
• Review Utilization Management authorization requests for medical necessity within established timelines
• Evaluate authorizations for outpatient referral, inpatient direct admissions, post-acute referral, and pharmacy
• Perform peer-to-peer discussions and build collaborative relationships with community and hospital providers
• Provide mentoring and coaching to UM nurses to strengthen Utilization Management effectiveness
• Support the ongoing development of Clover Health’s clinical guidelines and policies
• Maintain required medical credentials and board certifications

Business Analyst – Appeals & Grievances

Associate Chief Medical Officer, Medicare Advantage

Director, Clinical Business Operations

Senior Manager, Marketing

Cloud Infrastructure Engineer

Patient Enrollment Specialist, Korean Bilingual

Product Manager

Special Project Lead – Clinical Operations

Senior Manager, Quality Improvement

Commissions Manager, Medicare Advantage

Engineering Manager

Engineering Manager

Clinical Product Manager

Senior Director, HEDIS Operations

Director of Engineering Operations

Clinical Coding Manager

Technical Recruiter

Medical Director, Utilization Management