Clover Health

Data Analyst

• Build and maintain core Value-Based Care (VBC) performance metrics across risk, quality, utilization, and cost domains, including HCC capture rates, RAF scores, PMPM trends, and inpatient/ED utilization rates.
• Develop customer-facing analytics, reports, and dashboards that surface actionable performance insights for payer and provider partners in a clear, narrative-driven format.
• Analyze Medicare Advantage performance data, including risk adjustment, quality bonus payments, and benchmark performance, to identify gaps, trends, and opportunities at the patient, provider, and market level.
• Translate complex data findings into executive-ready narratives: written summaries, slide-ready visuals, and structured QBR materials that tell a coherent story about performance and next steps.
• Conduct deep-dive utilization and cost analyses, including high-cost claimant reviews, avoidable utilization patterns, and specialty/pharmacy spend trends, to identify levers for improvement.
• Partner with Customer Success and Provider Operations teams to prepare and deliver performance reviews (QBRs, monthly reporting packages) that communicate value and surface priority action areas for each customer.
• Collaborate with Data Engineering to validate claims and clinical data pipelines, flag anomalies, and ensure metric consistency across customer populations.
• Contribute to the development of scalable analytics infrastructure: reusable SQL libraries, metric definitions, and documentation that enable the team to move faster.

Data Analyst, Value-Based Care Analytics

• Proactively identify and monitor which healthcare facilities consistently generate high-quality, usable clinical documents (e.g., EHRs, discharge summaries, procedure notes) to precisely locate and quantify data gaps.
• Conduct deep-dive analyses by mapping and correlating facility-specific data across disparate sources like structured claims, clinical care summaries (CCDAs), and ADT messages to uncover systematic patterns of missingness, latency, or incongruence in clinical records.
• Establish and maintain clear, transparent reporting on ADT coverage across key geographic, organizational, and technological dimensions (e.g., by county, facility, and underlying EMR system).
• Based on rigorous analysis of data flow and quality, recommend and guide the implementation of optimal technical configurations for existing data vendors (e.g., Bamboo Health, PCC, Experian, HSX).
• Conduct comprehensive evaluations and proof-of-concepts for potential new data integration technologies (e.g., Kno2 vs. Particle Health) to assess viability, quality improvements, and strategic fit.
• Systematically determine the existence and completeness of documentation associated with specific patient visits or encounters.
• Develop a data-driven framework for prioritizing facility targets for direct data acquisition, assessing impact, cost-effectiveness, and technical feasibility.
• Inform and guide vendor strategy around national initiatives such as TEFCA and QHIN adoption, ensuring Counterpart Health is positioned for compliant, high-quality data exchange.
• Partner cross-functionally with Product Managers to define data requirements, Engineers to implement reliable pipelines, and Clinical teams to validate data quality and clinical utility.
• Act as a critical liaison to identify and remove operational and technical bottlenecks, ensuring a predictable, scalable, and reliable clinical data flow across all customer markets.

Data Analyst, Clinical Data Effectiveness

Engineering Manager

• Own the data platform end-to-end — architecture, tooling decisions, and roadmap — with a bias toward enabling broad, self-serve access to data across the business
• Be hands-on with Snowflake and DBT, contributing directly alongside the team on builds, migrations, and optimizations
• Integrate and rationalize a complex ecosystem of source systems and vendors into a cohesive, reliable data warehouse
• Define and evolve our approach to data modeling, including well-reasoned opinions on mart/gold layer design — when to enforce structure and when to get out of the way
• Make strategic build vs. buy decisions on tooling and vendor relationships, framing those decisions in terms of business and operational outcomes — not just technical elegance
• Design and evolve a data platform that is built for an AI-native organization — pipelines that serve LLM applications, infrastructure that supports agentic workflows, and tooling that compresses what used to take weeks into hours
• Use AI actively in your own workflow and bring strong opinions about where AI changes what a data platform needs to do and where it doesn’t
• Stay ahead of how AI is reshaping the role of data teams and translate that into concrete platform and staffing decisions
• Frame every platform decision in terms of business outcomes — operational efficiency, financial impact, clinical results. The data platform is a strategic enabler, not an isolated technical domain
• Partner with business stakeholders to translate data needs into platform capabilities without creating unnecessary friction or access barriers
• Make progress and tradeoffs visible to leadership as a natural byproduct of how you work
• Lead and develop a small high-impact team; setting a high bar for craft, communication, and ownership
• Think deliberately about team composition: what skills exist today, what gaps need to be filled, and how to sequence hiring to match the platform roadmap
• Invest in the growth of your team members, give clear feedback, create opportunities for ownership, and develop people who can grow with the platform

Head of Engineering, Data Platform

Artificial Intelligence

• Evaluate and bring on new AI tools and platforms, assessing fit for the team's workflows, managing setup and configuration, and driving adoption across the product organization.
• Lower the barrier to entry for non-engineers to leverage AI tools by packaging environments, simplifying setup, and removing infrastructure friction that blocks adoption.
• Solve the IT and security challenges required to deploy AI tools in a healthcare environment, setting up authentication flows, managing access patterns, and ensuring compliance with organizational security standards.
• Collaborate across the business—including product, engineering, design, IT, operations, commercial, and leadership teams—to identify workflows that can be accelerated with existing AI capabilities and get those tools running for the team.
• Create documentation, guides, and training materials that make it easy for non-technical team members to adopt and get value from new tools.
• Troubleshoot and maintain the AI tooling stack, diagnosing issues independently and iterating on configurations based on team feedback.

Senior AI Enablement Engineer

Cloud Engineer

• Own cloud infrastructure end-to-end across our cloud environments, staying hands-on with IaC, CI/CD, and observability alongside the team
• Own the SDLC surface area (dev environments, lower envs, release mechanics, monitoring and response) so engineers can ship in minutes rather than days
• Build the substrate that lets AI agents observe, reason, and act on business systems with safe defaults, and the rails that let AI-assisted apps from people outside of tech be deployed and supported without becoming operational liabilities
• Participate in security operations alongside our SecOps team on CSPM, threat management, and patch management as the infrastructure-side owner of remediations
• Frame infrastructure decisions in terms of business outcomes (operational efficiency, financial impact, clinical results), and make progress and tradeoffs visible to leadership as a natural byproduct of how you work
• Lead and develop a small, high-impact team, and operate as a peer to our SecOps, Data, IT Systems, and App Engineering leaders as a unifying technical force across the org

Principal Engineer, Cloud Infrastructure

Manager

• Lead end-to-end technical onboarding for new customers, including data integrations, EHR configurations, and platform setup, ensuring launches are on time and technically sound
• Serve as the primary technical account manager for a portfolio of enterprise customers post-launch, proactively surfacing and resolving technical issues before they impact care delivery
• Partner cross-functionally with Engineering, Product, Data, and Customer Integrations teams to represent customer needs and influence how we build and deliver
• Define and refine scalable onboarding playbooks and technical documentation that improve delivery consistency as the customer base grows
• Navigate complex, multi-stakeholder relationships — coordinating across clinical, IT, and operational contacts at customer organizations and across internal teams

Technical Solution Manager

Medical Billing and Coding

• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.
• Proactively identify overpayments to ensure accurate claims payments on inpatient services.
• Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.
• Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.
• Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification.

Inpatient Coder Associate, Payment Integrity

Software Engineer

• Own cloud infrastructure end-to-end across our cloud environments, staying hands-on with IaC, CI/CD, and observability alongside the team.
• Own the SDLC surface area (dev environments, lower envs, release mechanics, monitoring and response) so engineers can ship in minutes rather than days.
• Build the substrate that lets AI agents observe, reason, and act on business systems with safe defaults, and the rails that let AI-assisted apps from people outside of tech be deployed and supported without becoming operational liabilities.
• Participate in security operations alongside our SecOps team on CSPM, threat management, and patch management as the infrastructure-side owner of remediations.
• Frame infrastructure decisions in terms of business outcomes (operational efficiency, financial impact, clinical results), and make progress and tradeoffs visible to leadership as a natural byproduct of how you work.
• Lead and develop a small, high-impact team, and operate as a peer to our SecOps, Data, IT Systems, and App Engineering leaders as a unifying technical force across the org.

Director of Engineering – Infrastructure

Analyst

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Senior Analyst, Part D Spend

• First-Pass Accuracy Architecture: Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication. Ensure that complex member benefits and provider contract terms are perfectly synchronized with our accuracy goals.
• Strategic Process Optimization: Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers to ensure payment precision at the point of initial intake.
• Evolution of Automated Solutions: Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration. Utilize data-forward strategies to analyze configuration data, identify trends, and proactively mitigate payment inaccuracies.
• Cross-Functional Synergy: Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance. Ensure that plan designs and regulatory requirements are translated into actionable, high-precision configuration logic.
• Lean Team Leadership: Provide hands-on, "player-coach" leadership for a small, high-impact team of specialists, fostering a culture of excellence, accountability, and continuous technical learning.
• Technical Documentation: Develop best practices and documentation for advanced configuration procedures.

Senior Manager, Strategic Configuration

• Architect and execute comprehensive test plans to validate that member benefits, provider contract terms, and general edits—including LCD, NCD, and NCCI coding edits—are configured accurately within our systems.
• Develop and execute complex, scenario-based testing models that simulate real-world medical encounters to ensure configuration holds up under various coding conditions and modifier applications.
• Collaborate with the Senior Manager to provide detailed "failed-test" analysis and comprehensive impact assessments, documenting the financial and operational risk where configuration logic diverged from intended outcomes.
• Manage the technical validation lifecycle across testing and UAT environments to ensure "zero-defect" deployments into the live production environment.
• Simulate scenarios in a test environment to confirm the root cause of payment variances and validate that proposed configuration fixes work as intended.
• Support the evolution of our testing frameworks by utilizing LLMs to create test scenarios, summarize configuration requirements, and identify edge cases in complex reimbursement logic.
• Work closely with the core Configuration, Payment Integrity, and internal stakeholders to move logic from testing to production with high confidence.
• Maintain detailed records of test results, training materials, and configuration procedures to ensure transparency and compliance with CMS regulations.

Senior Strategic Configuration Analyst

Director

• Own the accountability for the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
• Design and oversee a robust, multi-layered audit program that monitors adjudication system output against clinical policies, pricing, benefit rules, and provider contract terms. Ensure that all findings are fed into a continuous improvement loop to enhance systemic accuracy.
• Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies and contract validation. You will independently utilize advanced LLMs (such as Claude, Gemini, and ChatGPT) to analyze oversight trends and develop data-driven criteria for judgmental sampling and targeted audits.
• Serve as the lead for global payment accuracy oversight regarding our external BPaaS partner, holding the vendor to world-class standards through global accuracy reviews and data-driven performance monitoring.
• Act as the strategic bridge between Clinical, Claims, A&G, UM, Compliance, Quality, and the Configuration team, ensuring that clinical intent, benefit design, and contractual terms are perfectly synchronized in the final payment adjudication.

Director, Claim Payment Accuracy

Business Analyst

• Own the accountability for the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
• Serve as the authority on Medicare guidelines, specifically interpreting and operationalizing NCDs, LCDs, and general national coding guidelines.
• Serve as the primary oversight for external vendor performance regarding policy monitoring and accuracy. Hold partners to world-class standards through data-driven performance reviews and collaborative workflow design.
• Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies. Utilize advanced LLMs (such as Claude, Gemini, and ChatGPT) to conduct regular deep research on ongoing industry trends.
• Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy intent is perfectly synchronized with technical adjudication.
• Act as the strategic bridge between Clinical, Claims, and Compliance teams to ensure a unified vision of payment excellence.

Business Analyst, Clinical & Reimbursement Policy

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Senior Analyst, Medicare Stars – Pharmacy Programs

• Partner directly with MSO and CCS leadership to drive “North Star” operations initiatives.
• Own ambiguous, cross-functional problems end-to-end—from diagnosis to execution.
• Build and run the operating system for provider growth and CA adoption, including metrics, reporting, and accountability mechanisms.
• Identify what’s broken (or missing), design solutions, and push them through to results.
• Diagnose and fix breakdowns in provider activation, onboarding, and ongoing utilization of Clover Assistant.
• Lead high-stakes projects, executive reporting, and board-level narratives.
• Own execution across Product, Analytics, Growth, and Provider Success—ensuring priorities translate into delivered outcomes, not stalled initiatives.