[Hiring] AI Analyst, Revenue & Cost Management @Clover Health

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Actuarial team at Clover is focused on leveraging data and technology to achieve financial excellence. As an AI Analyst , you will act as the critical Subject Matter Expert (SME) for the AI team. Your primary function is to bridge operational claims and revenue knowledge with advanced modeling efforts. You will translate complex business rules and data constraints into requirements for the modeling team, validate their results, and help measure the financial outcomes of our cost mitigation and revenue optimization solutions. • Claims Data & Logic SME: Act as the primary domain expert, providing detailed knowledge on the claims life cycle, configuration logic, payment rules, and common points of financial leakage within healthcare operations. • AI Model Support: Collaborate directly with the Lead AI Strategist to translate complex claims and financial scenarios into clear business logic and data features necessary for building predictive models. • Payment Integrity (PI) Validation: Partner directly with Claims Operations and UST to rigorously audit and validate that provider payments adhere to intended rules, supporting the definition of scope for the internal PI engine. • Revenue Optimization Support: Assist in data quality initiatives to enhance risk adjustment and revenue capture, including validating encounter data completeness and NPI fulfillment. • Financial Impact Analysis: Perform detailed, root-cause analysis on payment anomalies, outliers, and emerging claims cost trends flagged by the AI models to confirm financial impact and operational causes. Qualifications • 2+ years of experience in a quantitative analysis role focused on healthcare finance, such as claims operations, reimbursement, or payment integrity. • Foundational experience utilizing large-scale healthcare financial data (claims, encounters, provider networks) in a payer or related vendor setting. • Proficiency in SQL is required for data querying and manipulation, along with experience using basic statistical software (R, Python, or Excel) for data preparation. • Strong understanding of the healthcare claims life cycle, CPT/HCPCS/ICD-10 coding, and claims adjudication rules (Medicare Advantage experience is a plus). • Excitement about directly supporting the development and validation of AI and Machine Learning tools, and translating model outputs into actionable business rules. • Bachelor’s degree in Actuarial Science, Health Economics, Finance, or a related quantitative field is required. Benefits • Financial Well-Being : Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews. • Physical Well-Being : Comprehensive medical, dental, and vision coverage. • Mental Well-Being : Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. • Professional Development : 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! Apply tot his job