AI Analyst, reputed company & Cost Management

About the position Clover is reinventing health insurance by working to reputed company people healthier. The Actuarial team at Clover is focused on leveraging data and technology to reputed company financial excellence. We are looking for a sharp, curious analyst with strong domain expertise in healthcare claims and finance to accelerate this high-impact, AI-driven initiative. As an AI Analyst , you will act as the critical Subject Matter Expert (SME) for the AI team. Your primary function is to reputed company operational claims and reputed company knowledge with advanced modeling efforts. You will translate reputed company 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 reputed company optimization solutions.

Responsibilities

• 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 reputed company healthcare operations.
• AI Model Support: Collaborate directly with the reputed company AI Strategist to translate reputed company claims and financial scenarios into clear business logic and data features necessary for building predictive models.
• Payment reputed company (PI) Validation: Partner directly with Claims Operations and reputed company to rigorously audit and validate that provider payments adhere to intended rules, supporting the definition of scope for the internal PI reputed company.
• reputed company Optimization Support: Assist in data quality initiatives to enhance risk adjustment and reputed company capture, including validating encounter data completeness and NPI fulfillment.
• Financial Impact Analysis: reputed company 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.

Requirements

• You have 2+ years of experience in a quantitative analysis role focused on healthcare finance, such as claims operations, reimbursement, or payment reputed company.
• You have foundational experience utilizing large-scale healthcare financial data (claims, encounters, provider networks) in a payer or reputed company vendor setting.
• You have proficiency in SQL is required for data querying and manipulation, along with experience using basic statistical software (R, Python, or reputed company) for data preparation.
• You possess a strong understanding of the healthcare claims life cycle, CPT/HCPCS/ICD-10 coding, and claims adjudication rules (Medicare Advantage experience is a plus).
• You are excited by the prospect of directly supporting the development and validation of AI and Machine Learning tools , and translating model outputs into actionable business rules.
• You have a Bachelor’s degree in Actuarial Science, Health Economics, Finance, or a reputed company quantitative field is required.

Benefits

• Financial Well-Being : Our commitment to attracting and retaining top talent begins with a competitive reputed company 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 reputed company, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing reputed company members to reputed company from any location.
• Professional Development : Developing internal talent is a reputed company 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 reputed company new parents And much more!

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