At Clover Health, every member interaction is an opportunity to build trust and improve health outcomes. We're seeking a Performance Optimization Leader to build and lead the Quality Assurance function for Clover's Houston Experience Center. In this highly visible role, you'll establish and evolve the quality program that ensures every member interaction meets Clover's standards for accuracy, empathy, compliance, and exceptional service.
As the Performance Optimization Leader, you will own the end-to-end QA program, including quality standards, scorecards, calibration, governance, reporting, appeals, and continuous improvement. You'll partner closely with Operations, Training, HR, Compliance, and Member Experience leadership to translate quality insights into meaningful improvements for our members, agents, and leaders.
Success in this role requires balancing objectivity with partnership, using data to identify trends while ensuring QA remains a developmental function that drives continuous improvement, not simply compliance.
As a Performance Optimization Leader, you will:
- Own and continuously improve Clover's Quality Assurance program across all member interaction channels.
- Establish, maintain, and evolve quality standards, scorecards, rubrics, and evaluation methodologies that align with Clover's commitment to exceptional member experience and Medicare Advantage quality measures.
- Ensure quality evaluations are fair, consistent, timely, and supported by documented standards and governance.
- Build scalable QA processes that promote continuous improvement while maintaining regulatory and operational compliance.
- Explore emerging QA technologies, including AI-assisted review tools, to increase coverage and consistency without compromising the developmental, human-centered nature of the program.
- Lead the quality review process and ensure consistent application of evaluation standards across all reviewers.
- Facilitate recurring calibration sessions with Team Leads, Trainers, and Member Experience leadership to improve scoring consistency and reviewer alignment.
- Own QA governance, including inter-rater reliability, quality audits, appeals, reviewer development, and ongoing program enhancements.
- Serve as the primary escalation point for complex quality disputes and ensure findings are applied consistently and objectively.
- Maintain documentation, policies, and governance practices that support a transparent and trusted QA program.
- Analyze quality data to identify performance trends, coaching opportunities, knowledge gaps, process inefficiencies, and systemic issues impacting the member experience.
- Develop dashboards and executive reporting that provide meaningful insights into quality performance across teams and leaders.
- Partner with Operations and Training to ensure quality findings inform coaching strategies, training priorities, and process improvements.
- Identify opportunities to improve member outcomes by reducing recurring quality issues and strengthening operational processes.
- Champion a culture where quality assurance is viewed as a strategic business function focused on learning, accountability, and continuous improvement.
- Partner with Member Experience leadership to align quality initiatives with operational goals and organizational priorities.
- Collaborate with Training, Compliance, HR, Product, and Operations teams to resolve systemic issues identified through quality reviews.
- Provide data-driven recommendations that influence operational strategy, customer experience improvements, and leadership decision-making.
- Serve as the subject matter expert for Quality Assurance across the Houston Experience Center
Success in this role looks like:
- Within the first 90 days, success will be defined by establishing credibility with Operations leadership, implementing consistent QA processes, launching regular calibration sessions, and delivering quality reporting that leaders trust and act upon.
- Within the first 6 months, success will be defined by improving scoring consistency, strengthening QA governance, identifying meaningful quality trends, and partnering with leaders to improve coaching effectiveness and member experience outcomes.
- Long-term success will be defined by building a mature Quality Assurance program that drives measurable improvements in quality performance, member experience, leadership accountability, and operational excellence while serving as a trusted strategic partner across the organization.
You should get in touch if you:
- Have 7+ years of experience in Quality Assurance, Contact Center Operations, Customer Experience, or operational excellence, including experience leading QA programs.
- Have experience designing, implementing, or scaling Quality Assurance programs in healthcare, insurance, or another regulated customer service environment.
- Have deep knowledge of quality methodologies, calibration, scorecard development, and performance analytics.
- Have demonstrated success using quality data to influence operational strategy and improve customer outcomes.
- Have exceptional analytical skills and experience developing dashboards and executive-level reporting.
- Are comfortable leading cross-functional initiatives and influencing stakeholders without direct authority.
- Excel at balancing accountability with coaching and can build trusted partnerships across Operations, Training, HR, and Compliance.
- Have excellent written and verbal communication skills and are comfortable presenting recommendations to senior leadership.
- Have experience supporting Medicare Advantage, CMS quality programs, CAHPS, HIPAA, or regulated contact center environments is strongly preferred.
- Have experience with quality management platforms, speech analytics, AI-assist QA, or business intelligence tools is a plus.
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 Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
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.
