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Role Summary

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HIGHLIGHTS

Health-focused AI analyst on Clover's Actuarial team supporting revenue optimization and cost mitigation. You'll act as claims SME, translate business rules into features, validate AI model outputs, and measure financial impact. Remote-first role requiring 2+ years in healthcare finance or claims analytics (US).

JOB DESCRIPTION SUMMARY

  • Serve as claims data and payment rules SME for AI model development
  • Support predictive modeling and validate model outputs for financial impact
  • Work on payment integrity, risk adjustment, and revenue capture initiatives
  • Required: 2+ years in healthcare finance/claims and strong SQL skills
  • Remote-first position with competitive salary, equity, and benefits

DOMAIN EXPERTISE

  • Healthcare claims operations and payment integrity
  • Experience with large-scale healthcare financial data (claims, encounters, providers)
  • Proficiency in SQL for data querying and manipulation
  • Understanding of CPT/HCPCS/ICD-10 coding and claims adjudication rules
  • Exposure to risk adjustment and revenue capture validation

KEY REQUIREMENTS

  • 2+ years in quantitative healthcare finance, claims, reimbursement, or PI
  • Bachelor's degree in Actuarial Science, Health Economics, Finance, or related
  • Proficiency in SQL for data querying and manipulation
  • Experience using R, Python, or Excel for data preparation
  • Strong understanding of claims life cycle and CPT/HCPCS/ICD-10 coding

TECH STACK

  • Excel
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Role Summary

Loading...

HIGHLIGHTS

Health-focused AI analyst on Clover's Actuarial team supporting revenue optimization and cost mitigation. You'll act as claims SME, translate business rules into features, validate AI model outputs, and measure financial impact. Remote-first role requiring 2+ years in healthcare finance or claims analytics (US).

JOB DESCRIPTION SUMMARY

  • Serve as claims data and payment rules SME for AI model development
  • Support predictive modeling and validate model outputs for financial impact
  • Work on payment integrity, risk adjustment, and revenue capture initiatives
  • Required: 2+ years in healthcare finance/claims and strong SQL skills
  • Remote-first position with competitive salary, equity, and benefits

DOMAIN EXPERTISE

  • Healthcare claims operations and payment integrity
  • Experience with large-scale healthcare financial data (claims, encounters, providers)
  • Proficiency in SQL for data querying and manipulation
  • Understanding of CPT/HCPCS/ICD-10 coding and claims adjudication rules
  • Exposure to risk adjustment and revenue capture validation

KEY REQUIREMENTS

  • 2+ years in quantitative healthcare finance, claims, reimbursement, or PI
  • Bachelor's degree in Actuarial Science, Health Economics, Finance, or related
  • Proficiency in SQL for data querying and manipulation
  • Experience using R, Python, or Excel for data preparation
  • Strong understanding of claims life cycle and CPT/HCPCS/ICD-10 coding

TECH STACK

  • Excel

Job Overview

Salary
$120k - $140k
Years of Experience
2+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

An Associate-level analyst with 2+ years in health payer analytics, strong SQL skills, familiarity with claims coding and adjudication, and experience translating claims data into predictive model features.

Benefits

Equity/Stock OptionsAnnual Bonus401(k) PlanHealth InsuranceDental InsuranceVision InsuranceWellness ProgramRemote FirstPaid Parental LeaveHome Office Stipend
Shortlist Forming
Closing Soon
19d
19 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

Job Overview

Salary
$120k - $140k
Years of Experience
2+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

An Associate-level analyst with 2+ years in health payer analytics, strong SQL skills, familiarity with claims coding and adjudication, and experience translating claims data into predictive model features.

Benefits

Equity/Stock OptionsAnnual Bonus401(k) PlanHealth InsuranceDental InsuranceVision InsuranceWellness ProgramRemote FirstPaid Parental LeaveHome Office Stipend
Shortlist Forming
Closing Soon
19d
19 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

Health/Insurtech/IC Level
Clover Health

AI Analyst, Revenue & Cost Management

Clover Health•United States•2w ago
RemoteMedicare AdvantagePredictive Modelling & MLData EngineeringBusiness Intelligence & Reporting

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