Clover Health · 18 hours ago
Director, HEDIS Operations
United States
Full-time
Remote
Senior Level, Lead/Staff
$176K/yr - $200K/yr
10+ years expClover Health is dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. As the Director of HEDIS Operations, you will manage HEDIS abstraction processes, ensuring the organization maintains its industry-leading performance while collaborating with technical, analytical, and clinical teams to operationalize HEDIS results.
Health CareHealth InsuranceHospitalMedical
Responsibilities
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
Qualification
Required
10+ years of experience leading HEDIS or Stars operations for a Medicare Advantage plan or vendor
Deep expertise in HEDIS abstraction processes, NCQA specifications, CMS Stars methodology, and audit practices
Successfully managed hybrid and prospective review models at scale
Known for achieving high HEDIS and Stars performance and can point to direct impact on outcomes
Thrive in high-stakes, outcomes-driven environments and can step in quickly to deliver results
Benefits
Competitive base salary and equity opportunities
Performance-based bonus program
401k matching
Regular compensation reviews to recognize and reward exceptional contributions
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Access to mental health resources
Generous flexible time-off policy
Learning programs
Mentorship
Professional development funding
Regular performance feedback and reviews
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
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
Fierce Healthcare
2026-01-19
2026-01-16
Company data provided by crunchbase