Clover Health - Payment Integrity Analyst

• Data Fluency: Gaining a deep understanding of Clover’s specific claims, enrollment, and clinical data schemas. • Technical Integration: Demonstrating proficiency in the tech stack, including expert-level SQL and GitHub protocols (branching, merging, and pull requests). • Initial Concept Development: Translating at least two net-new medical cost-saving concepts into functional SQL code for automated deployment. • Portfolio Growth: Owning and maintaining the full portfolio of Clover’s automated cost-saving concepts. • Reporting Autonomy: Generating accurate monthly and quarterly Payment Integrity financial reports with minimal oversight. • Cross-Functional Influence: Leading discussions with clinical staff and billing experts to turn complex data into actionable operational improvements. • Workflow Optimization: Effectively leveraging AI-assisted tools to accelerate query writing and data cleaning, showing an increase in team velocity. • Subject Matter Expertise: Being the "go-to" person for the data and engineering teams when payment integrity processes intersect with broader data issues. • Policy Evolution: Successfully advocating for and implementing systemic changes to claims payment policies based on your data-driven insights. • Scalability: Developing a robust library of automated audits that require minimal maintenance while catching high-value payment errors at scale. • You should get in touch if: • You have experience working with complex processes in a technical environment and synthesizing data for senior leadership. • You have 2+ years of experience with expert-level SQL proficiency and a deep background in healthcare claims analysis. • You are expert at leveraging AI-assisted workflows to accelerate complex query writing and data cleaning. Highly skilled in translating claims data into actionable insights using Excel, Visio/Lucid, and Google Suite. • You hold a BA/BS degree or equivalent experience along with 5+ years of experience in the data and analytics space. • You have 2+ years of experience working in healthcare data, preferably Medicare related. • You have experience with GitHub (branching, merging, pull requests) and move-to-production protocols. • You have a working knowledge of CMS rules and regulations.