Performance Optimization Leader

About this role

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 ta

Similar jobs

• Performance Improvement Operations Consulting Manager — Crowe · Chicago IL USA | Nashville TN USA | Dallas TX USA
• Performance Improvement Fellow — Vizient · Chicago, IL
• Practice Optimization Partner — Ensemble Health Partners · Indianapolis, IN
• Tech Lead, Performance Evaluation — Maymobility · Remote
• Performance Improvement Coordinator — MedImpact · Tempe, AZ
• Performance Engineer - Performance Analysis & Tuning — Supabase · Remote
• AI Optimization Lead — RELX (LexisNexisLegal) · Dayton, OH (Springboro Pk)
• Performance Improvement Operations Senior Consultant — Crowe · Chicago IL USA | Nashville TN USA | Houston TX USA