Gather requirements from stakeholders and translate to specific and actionable work tasks.
Develop complex SQL queries to support data-driven insights that inform business and clinical decisions.
Analyze healthcare data (claims, lab, pharmacy and EMR data) to draw conclusions and provide consultation to stakeholders for use in administering specific programs and operational processes.
Develop reports, dashboards, and visualizations that provide insights into various patient populations and health care utilization patterns.
Partner closely with clinical and operational teams to ensure data-driven decision-making and assist in the assessment of treatment concordant care.
Analyze CCS operations relative to goals and summarize the completion of routine tasks by various business unit resources.
Ensure data accuracy, quality, and integrity when working across multiple data sets.
Prepare and present findings and recommendations to leadership, internal clinical teams, and external stakeholders in support of Clover Care Services business initiatives.

Requirements

You have a BA/BS in Mathematics, Statistics, Economics, Healthcare, or a related discipline, with 5+ years of relevant professional experience.
You have strong SQL proficiency with experience querying, summarizing, and manipulating large healthcare datasets.
You have hands-on experience analyzing medical and pharmacy claims data, including medical cost modeling, utilization analysis, trend analysis, and PMPM calculations.
You have experience with healthcare actuarial concepts, including risk adjustment methodologies (e.g., HCC, RAF), population risk stratification, and enrollment/eligibility analysis.
You have knowledge of healthcare data standards and coding systems (ICD-10, CPT, DRG) and familiarity with healthcare quality measures (e.g., HEDIS, CMS, NCQA), preferably within Medicare Advantage.
You have the ability to validate data quality, identify anomalies, document analytical assumptions, and perform member-level longitudinal analyses.
You have strong communication skills with the ability to translate complex analytical findings into clear, actionable insights and present them to actuarial, clinical, financial, and operational stakeholders using tools such as Excel and data visualization platforms (e.g., Tableau, Power BI).

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.
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!

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLdata analysismedical claims analysispharmacy claims analysiscost modelingutilization analysistrend analysisPMPM calculationsrisk adjustment methodologiespopulation risk stratification

Soft Skills

communicationstakeholder engagementanalytical thinkingpresentation skillscollaboration