Note: The job is a remote job and is open to candidates in USA. Clover Health is an AI-powered physician enablement platform that delivers clinical insights to providers at the point of care. The Data Analyst role focuses on translating complex clinical and financial data into actionable insights for payer and provider partners, while building and maintaining performance metrics in value-based care.
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
Skills
- 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
Benefits
- Competitive base salary and equity opportunities
- Performance-based bonus program
- 401k matching
- Regular compensation reviews to recognize and reward exceptional contributions
- Comprehensive medical, dental, and vision coverage
- No-Meeting Fridays
- Monthly company holidays
- Access to mental health resources
- Generous flexible time-off policy
- Remote-first culture that supports collaboration and flexibility
- Learning programs
- Mentorship
- Professional development funding
- Regular performance feedback and reviews
- 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
Company Overview