Senior Strategic Configuration Analyst

About the role

The is entrusted with the critical mission of protecting the integrity of claim payment processing across the enterprise. This role operates within a lean, high-impact team dedicated to ensuring first-pass adjudication accuracy and compliance. You will own the technical validation of system logic before any configuration goes live to production environments. A core part of this position involves translating complex contractual terms and clinical business rules into precise and testable validation workflows. You act as a technical specialist designed to shield members from potential billing errors and financial risk. The position requires a partnership mindset to bridge the gap between technical configuration and business intent. Success is measured by your ability to prevent payment variances before they impact the member experience.

Key facts

What you'll do

• Execute the work scope defined for the Senior Strategic Configuration Analyst role at Clover Health, ensuring alignment with strategic objectives.
• Adhere to all guidelines and procedures detailed
• Architect, document, and execute comprehensive test plans specifically for member benefits and provider contracts within the system.
• Validate complex business logic configurations, including LCD, NCD, and NCCI coding edits as they exist in the production systems.
• Design intricate scenario-based models that accurately replicate real-world medical encounters and diverse provider scenarios.
• Test configuration robustness under a wide array of coding conditions, modifier applications, and regulatory variations.
• Perform detailed impact analysis whenever payment variances are detected to expose underlying financial risk.
• Measure deviations against clinical intent and regulatory expectations to ensure compliance standards are met.
• Simulate the specific conditions that trigger variances within a controlled test environment to identify root causes.
• Verify all configuration fixes through rigorous testing cycles prior to any deployment into the live production environment.
• Manage the end-to-end technical validation lifecycle, overseeing both testing and User Acceptance Testing (UAT) processes.
• Ensure that no critical defects are allowed to progress to production, maintaining the highest standard of system integrity.
• Utilize Large Language Model (LLM) tools strategically to generate test scenarios, clarify ambiguous requirements, and accelerate validation cycles.
• Identify and analyze edge cases that exist within complex reimbursement logic and payment rules.
• Foster collaboration with Configuration, Payment Integrity, and key stakeholders to move logic from testing into production with confidence.
• Maintain detailed technical documentation of test results, configuration procedures, and validation steps for auditability.
• Ensure all documentation supports transparency and compliance with current CMS regulations and internal governance policies.

Requirements

• Must hold 5+ years of cumulative experience in Medicare Advantage configuration, testing, or technical quality assurance roles.
• Must demonstrate mastery of the HealthEdge HRP and Source environments, including hands-on experience with configuration management.
• Must possess the ability to build and execute test cases that ensure strict adherence to regulatory compliance standards.
• Must be capable of interpreting dense provider contracts and clinical rules to ensure precise execution within system logic.
• Must have proven experience validating complex logic under varied coding conditions, modifiers, and regulatory scenarios.
• Must be able to communicate complex findings, technical issues, and business impacts clearly to both technical and business audiences.
• Must hold the right to work in the United States and be eligible for full-time employment without sponsorship.
• Must thrive in a detail-oriented environment where accuracy and precision are non-negotiable requirements.
• Must be comfortable working remotely while maintaining rigorous communication and documentation standards.
• Must be analytical, patient, and passionate about discovering logic flaws through systematic simulation and testing.

Nice to have

• Preferred experience with AI tools such as Claude, Gemini, and ChatGPT to enhance testing efficiency.
• Background in payment integrity, claims adjudication, or revenue cycle management within a health plan setting.
• Familiarity with regulatory frameworks specific to Medicare and federal healthcare guidelines.

Practical notes

This is a full-time remote position based in the United States. The role reports directly to the Senior Manager, Strategic Configuration. Compensation for this position is set at $140,000.00 annually. Engagement is full-time. This position may involve occasional virtual collaboration with team members across different regions. Visa sponsorship is not available for this role. Candidates must ensure they meet the eligibility requirements stated in the requirements section. Please The start date is contingent upon final approval and background check completion.