Director, HEDIS Operations

At Clover Health, we are dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. Initially scaled within our own Medicare Advantage provider network, we have built an innovative technology platform, designed to put actionable clinical insights into the hands of physicians at the point of care. In 2024, Clover’s PPO plan achieved an industry leading 4.94 stars in HEDIS, with significant impact driven by its innovative technology - Counterpart Assistant. Read more about how CA drove this improvement in our case study here. 

As the Director of HEDIS Operations, you will own and run Clover Health’s HEDIS abstraction processes, ensuring our organization sustains and extends its industry-leading HEDIS and Stars performance. You will be directly responsible for achieving outcomes in Measurement Year 2025 and beyond, bringing unmatched expertise in abstraction, audit readiness, and numerator/exclusion management. You will work across technical, analytical, and clinical teams to operationalize HEDIS results and deliver measurable impact.

As a Director of HEDIS Operations, you will:

• 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.

Success in this role looks like:

• Achieving top-tier results in HEDIS MY2025, sustaining Clover Health’s track record of leading HEDIS performance.
• Ensuring abstraction accuracy that withstands auditor scrutiny with no material audit findings.
• Closing gaps at scale, driving measurable improvements in high-priority measures.
• Translating measure logic into operational workflows that consistently deliver numerator hits and exclusions.
• Being recognized internally and externally as the “go-to” expert on HEDIS operations and performance improvement.
• Managing a team of abstractors and operators running a year round process, from admin and hybrid prior year abstraction and chase to prospective year abstraction and chase. 

You should get in touch if:

• You have 10+ years of experience leading HEDIS or Stars operations for a Medicare Advantage plan or vendor.
• You have deep expertise in HEDIS abstraction processes, NCQA specifications, CMS Stars methodology, and audit practices.
• You have successfully managed hybrid and prospective review models at scale.
• You are known for achieving high HEDIS and Stars performance and can point to direct impact on outcomes.
• You thrive in high-stakes, outcomes-driven environments and can step in quickly to deliver results.

Benefits Overview: 

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. 
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• 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
• And much more!

About Counterpart Health: In 2018, Clover Health set out to do something unprecedented: build a clinically intuitive, AI-enabled solution that fits within physicians' workflows to help support the earlier diagnosis and management of chronic conditions.

Years later, that vision is a reality, with thousands of practitioners using Counterpart Assistant during patient visits to improve disease management, reduce medical expenses, and drive success in value-based care.

With an exceptional team of value-based care and technology experts, Counterpart Health is driving value-based care at the speed of software.

Counterpart Health is a subsidiary of Clover Health. From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.

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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

A reasonable estimate of the base salary range for this role is $176,000 to $200,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.