Clover Health - Data Analyst, Value-Based Care Analytics
Requirements
• 4+ years of hands-on healthcare data analytics experience, with direct exposure to payer or provider customers in a value-based care context. • Deep familiarity with VBC metrics: risk adjustment (HCC coding, RAF scores), utilization (IP admissions, ED visits, readmissions), and cost (PMPM, total cost of care, benchmark vs. actual). • Strong SQL skills, able to write complex queries across claims, eligibility, and clinical datasets in cloud-based warehouses (BigQuery, Snowflake, or similar). • Exceptional data storytelling ability: you can translate analytical findings into clear narratives and visuals that resonate with both clinical and non-technical audiences. • Experience building customer-facing reports and dashboards; comfortable presenting findings to external stakeholders (health plans, provider groups, ACOs). • Medicare Advantage experience, including familiarity with CMS risk adjustment models (CMS-HCC v24/v28), Star Ratings methodology, and MA quality bonus payment structures. • Familiarity with clinical terminologies: ICD-10, CPT/HCPCS, NDC, SNOMED, LOINC. • Experience using Python or R for data manipulation, cohort analysis, or statistical modeling. • Background working with EHR or clinical data alongside claims (e.g., for care gap closure, chronic condition identification, or attribution logic). • Prior experience in a health plan, risk-bearing provider group, ACO, or health tech company supporting VBC programs.
Responsibilities
• 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.
Benefits
• 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 • Years later, that vision is a reality, with thousands of practitioners using Counterpart Assistant during patient visits to improve disease management, reduce medical expenses, and drive success in value-based care. • With an exceptional team of value-based care and technology experts, Counterpart Health is driving value-based care at the speed of software.
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