Clover Health

Data Engineer

• Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
• Own the claim and supplemental submission workflow for CMS EDS submissions.
• Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors.
• Support the claim and supplemental submission workflow for CMS EDS submissions.
• Collaborate closely between the Engineering and Risk Adjustment teams.
• Assist with, track, and implement risk adjustment related initiatives and strategies.
• Maintain, update, and create policies, procedures, and other documentation around the encounter process.

CMS Encounter Data Engineer

Analyst

• Identify, develop, and deploy a portfolio of cost-saving concepts and initiatives that drive specific and measurable results for Clover.
• Translate individual concepts into SQL code that can be deployed in an automated fashion against Clover's pending and/or paid claims data.
• Support existing and develop new medical record review and administrative hold concepts/edits to drive specific and measurable results.
• Lead cross-functional discussions with billing experts, clinical staff, and operations managers to translate complex claims data into operational improvements.
• Train other members of the team to create SQL code for minor reporting or quick analysis.
• Support the team with daily operational tasks such as triaging Salesforce tickets, assisting with audit letter creation, and reimbursement processing.
• Influence senior leadership to adopt new policies, procedures, concepts, and initiatives to drive claims payment accuracy and medical cost containment.
• Act as a subject matter expert on all things data-related, including claims, enrollment, and clinical. Partner with data and engineering teams to investigate data issues when they intersect with payment integrity processes.
• Generate monthly, quarterly, and annual payment integrity financial reports as well as ad-hoc reports to support operational functions.

Payment Integrity Analyst

Director

• The role applies advanced analytics, data engineering, & statistical modeling to large healthcare operational datasets to generate insights for organizational decision making.
• The employee leads the strategy, design, & optimization of an enterprise analytics platform on Google Cloud Platform, using BigQuery, Apache Beam, Airflow, Kubernetes, & Tableau.
• They oversee development of data pipelines, semantic layers, & reporting systems for BI tools including Mode, Looker, & Tableau.
• Projects focus on value-based care operations, including risk adjustment, claims analytics, quality reporting, & executive dashboards.
• The work supports providers & payers in improving outcomes & efficiency through analytics, with platforms built for operational, financial, & quality data not clinical trial or research data.
• Manage a team of data scientists, analysts, and BI developers to most effectively drive impact for our users and their patients.
• Focus on identifying and solving the highest impact analytics data platform enhancements both for our users and our business simultaneously.
• Be accountable to analytics that drive outcomes.

Director, Analytics

Recruitment

• Own full-cycle recruiting for key teams within Counterpart Health and Clover Care Services, partnering with senior leadership to design strategic hiring plans and effective job descriptions.
• Navigate the build-from-scratch environment of a scaling business unit, developing creative sourcing tactics to engage passive talent in new and existing markets, educating new hiring managers to our process and values, and increasing pipeline diversity.
• Be a strategic advisor to hiring managers, helping them understand role scope and business objectives while holding teams accountable to an equitable and rigorous interview process.
• Master the data by leveraging our tech stack to identify blockers, build performance dashboards, and provide meaningful solutions for process improvement.
• Enhance the Clover talent brand to attract top-tier candidates who are mission-aligned and eager to tackle complex healthcare challenges.
• Collaborate across People Operations on large-scale projects, helping to mentor junior team members and evolve our talent strategy.

Recruiter, Provider Engagement – Success

Data Analyst

• 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.

Senior Clinical Data Analyst

Operations

• Lead operational strategy for national provider engagement programs, including onboarding, education, performance management, and support
• Define what provider success looks like nationally, including success metrics, KPIs, and performance standards
• Translate value-based care strategy into scalable, repeatable operational processes
• Establish and evolve core provider success workflows, playbooks, and engagement models
• Approve changes to core provider success processes, tooling, and engagement approaches
• Set national priorities, sequencing, and investment focus for provider success initiatives
• Translate enterprise strategy into clear expectations and priorities for regional provider success leaders
• Provide strategic frameworks, tools, and guidance for consistent account planning and execution
• Ensure alignment between national standards and regional execution, balancing standardization with local market realities
• Partner with regional leaders to identify systemic barriers impacting provider success and drive cross-functional solutions
• Build, lead, and develop a high-performing national provider success operations team
• Establish clear goals, accountability structures, and performance management tied to national outcomes
• Support national growth through scalable operational and account management models
• Contribute to enterprise planning for new market launches, program expansions, and provider network growth
• Provide interim leadership support to field teams during periods of expansion or transition, as needed

Director of Operations, Provider Success

Actuary

• Own the end-to-end monthly Incurred But Not Reported (IBNR) accrual process, ensuring the development and maintenance of adequate reserve levels for timely financial close.
• Maintain and uphold robust SOX controls across all reserving and reporting processes, including meticulous documentation of processes, assumptions, and actuarial judgments for audit readiness.
• Own the Member Level Financial Pipeline Development and Maintenance, including implementing and reviewing control checks and peer reviews to validate data accuracy for strategic financial goals.
• Lead the preparation and review of the comprehensive monthly financial reporting suite and conduct in-depth variance analysis (actuals vs. budget) for management and external stakeholders.
• Foster a positive work environment, set clear performance expectations, actively support the professional growth of team members through mentorship, and ensure strong collaboration across departments.

Manager, Actuarial Reserving and Financial Reporting

Medical Director

• The Medical Director, Utilization Management, will be responsible for the evaluation of all outpatient referrals and inpatient direct admissions for medical appropriateness.
• The physician will utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, Clover Health’s medical policies reviews to determine medical necessity or if an alternate treatment plan is required for our members.
• Successfully completes all required new hire training modules and certifications
• Demonstrates a foundational understanding of Clover Health's medical policies, guidelines, and utilization management processes
• Begins to independently review cases with increasing efficiency and accuracy, requiring minimal oversight
• Establishes positive working relationships with team members and key stakeholders
• Consistently meets or exceeds productivity targets for case reviews and determinations
• Maintains a high level of accuracy in medical necessity determinations and documentation
• Actively participates in team meetings and contributes to process improvement discussions
• Demonstrates a comprehensive understanding of complex medical cases and escalates issues appropriately.

Medical Director, Utilization Management – Part Time, Weekends

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Medical Director, Payment Integrity – Utilization Management

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

Auditor

• Partner with Clinical, Claims, and SIU peers to review claims for billing and coding related issues on a retrospective basis that currently drive inaccurate payments to providers or indicate FWA.
• Identify control opportunities to mitigate FWA.
• Identify possible audit opportunities.
• Support annual FWA audit goals.
• Support provider conversations around FWA audit findings.
• Manage overall audit workload to ensure timely and accurate audit results.
• Work closely with senior team members and management on targeted projects and initiatives.
• Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.

Medical Claims Auditor

Business Analyst

• Data Translation & Storytelling: Bridge the gap between technical data and business value; collaborate closely with the Analytics team to translate complex datasets into clear, cohesive narratives and high-quality presentations for various stakeholders.
• Reporting Infrastructure: Design and build the reporting frameworks necessary to capture critical metrics and extend the capabilities of the Account Management team.
• Performance Management: Support the development and maintenance of a performance management system to track and drive team and provider success.
• Stakeholder Engagement: Create compelling slide decks and data visualizations that focus on boosting provider engagement and performance.
• Strategic Support: Act as a thought partner to the Provider Engagement leadership, identifying trends and opportunities to improve provider adoption and delight.

Senior Business Analyst

• Manage key elements of the recovery workflows and communications to ensure Clover is accurately paying claims and partnering with Providers in an efficient, streamlined manner.
• Support the team with daily operational tasks such as triaging and responding to provider disputes and inquiries.
• Work cross-functionally across Payment Integrity, Claims, Provider Solutions, and other stakeholders to drive financial savings and maintain strong provider relationships.
• Incorporate cross-functional perspectives and business needs in solving complex problems.
• Support subject matter experts to improve team efficiency and maximize team ROI.
• Help shape the department by contributing to process documentation and training (e.g., meeting minutes, workflows and standing operating procedures).

Operations Specialist, Payment Integrity

Solutions Engineer

• Evaluate end-to-end workflows across ERP, EPM, CRM, CMS platforms and associated applications by working with cross functional business teams to identify automation opportunities and optimize performance.
• Act as a partner with cross-functional IT teams and stakeholder leaders, ensuring systems and processes align with evolving business priorities - including the organization's AI strategy.
• Redesign and standardize processes to increase accuracy, reduce cycle times, and improve end-user experience.
• Lead and administer planning, testing, and deployment of new features and technologies to ensure smooth adoption and minimal business disruption.
• Be responsible for change management documentation and application standardized training.
• Prioritize and administer enhancement requests based on strategic value, data-driven impact, and resource availability.
• Manage competing deadlines with structured project management practices.
• Ensure seamless operation of data integrations, monitoring daily data flows and proactively mitigating disruptions.
• Serve as the escalation point for complex system issues, coordinating resolution with internal technical and business teams and external vendors.
• Lead application releases, validations, configurations, upgrades, and issue resolution.
• Serve as application administrator for supported business applications and troubleshooting.
• Translate SOX requirements into tangible tech solutions, making compliance more efficient, continuous, while reducing costs and risk.

Business Systems Solution Architect

Procurement

• Lead end-to-end procurement activities for assigned categories, including RFXs, supplier selection, negotiations, and contract execution.
• Review, negotiate, and finalize supplier agreements to secure favorable commercial terms while ensuring compliance with internal policies and external regulations.
• Prepare and issue preliminary redlines to supplier agreements to protect commercial terms and mitigate risk; escalate for formal legal review as needed.
• Collaborate cross-functionally with Legal, Security, Accounts Payable (AP), and Finance to ensure seamless contract lifecycle management and alignment with business requirements.
• Design, implement, and optimize procurement process flows and documentation to improve cycle times, accuracy, and governance.
• Manage contract repositories and maintain a centralized, searchable index of all active and historical contracts; ensure version control and easy retrieval.
• Produce forward-looking procurement reports and dashboards (e.g., spend analytics, supplier performance, pipeline of commitments) to support strategic decision-making.
• Identify opportunities for cost reduction, supplier consolidation, and value-added services without compromising quality or risk posture.
• Ensure compliance with internal controls, procurement policies, and regulatory requirements; support internal and external audits as needed.
• Develop strong supplier relationships, conduct supplier risk assessments, and monitor performance against agreed SLAs and KPIs.
• Mentor and coach junior procurement staff, fostering a culture of continuous improvement and procurement excellence.