[Remote] AI Analyst, Revenue & Cost Management

Note: The job is a remote job and is open to candidates in USA. Clover Health is reinventing health insurance by leveraging data and technology to achieve financial excellence. The AI Analyst will serve as a Subject Matter Expert, bridging operational claims knowledge with advanced modeling efforts to support cost mitigation and revenue optimization solutions. 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 Skills • 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 • 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 • Bachelor's degree in Actuarial Science, Health Economics, Finance, or a related quantitative field is required • 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 Benefits • Competitive base salary and equity opportunities • Performance-based bonus program • 401k matching • Regular compensation reviews • Comprehensive medical, dental, and vision coverage • No-Meeting Fridays • Monthly company holidays • Access to mental health resources • Generous flexible time-off policy • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities • Reimbursement for office setup expenses • Monthly cell phone & internet stipend • Paid parental leave for all new parents Company Overview • Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans. It was founded in 2014, and is headquartered in Nashville, Tennessee, USA, with a workforce of 501-1000 employees. Its website is http://cloverhealth.com. Apply Now Apply Now