Clover Health · 3 weeks ago
AI Analyst, Revenue & Cost Management
United States
Full-time
Remote
Entry, Mid Level
$120K/yr - $140K/yr
2+ years expClover Health is reinventing health insurance by leveraging data and technology to promote better health outcomes. The AI Analyst will serve as a Subject Matter Expert, bridging operational claims and revenue knowledge with advanced modeling efforts to support AI-driven initiatives in healthcare finance.
Health CareHealth InsuranceHospitalMedical
Responsibilities
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
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
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
Assist in data quality initiatives to enhance risk adjustment and revenue capture, including validating encounter data completeness and NPI fulfillment
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
Qualification
Required
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)
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
Bachelor's degree in Actuarial Science, Health Economics, Finance, or a related quantitative field is required
Benefits
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.
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!
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
H1B Sponsorship
Clover Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase