Data Product Management, Claims

Clover Health, San Francisco, CA | Jersey City, NJ | Remote

Clover is a Medicare Plan done differently.

Clover is reinventing health insurance by working to keep people healthier.

Clover uses our unique position as a data driven insurance company to deliver targeted interventions and coordinate care for our member population. We intend to prove that healthcare can be both high quality and cost-effective and are growing Clover's Data Management team to build and maintain high quality data products in service of our mission. Our team is responsible for developing deep domain expertise around our core data, operational processes, and technology landscape. We work collaboratively with cross functional teams to build data products, design processes, and author policies aimed at improving data quality, usability, and accessibility.

In this role, you will have the opportunity to partner closely with product, operations, and engineering to deliver a coordinated, strategic, and pragmatic approach to data quality and usability initiatives. Our ideal candidate has expertise working with healthcare claims and possesses technology acumen, having worked extensively with claims data in an analytic, consulting, and/or product development capacity.

As a senior member of our Data Management team, you will:

  • Delve into issues experienced when using our data, performing root cause analyses to identify the problem, propose solutions, and facilitate implementation of the solution.
  • Cultivate and evangelize data governance processes and policies to make and keep Clover's data trustworthy and discoverable.
  • Work closely with internal teams and external entities involved in the claims process to understand Clover's claims data and the processes by which the data is produced, validated, transformed by each entity in the lifecycle.
  • Partner with teams who are consumers of claims data (machine learning, payment integrity, insurance operations) to understand the needs of these teams and develop a data product strategy for maximizing usability of claims data.
  • Act as the domain expert for claims data, educating teams throughout the organization on the nuances of claims data when relevant to their projects and strategies.
  • Create business rules for monitoring data quality at different stages in the pipeline, alerting stakeholders of incidents, and create a feedback loop to fix the data at the source.

You will love this job if:

  • You are not afraid of big, complicated problems and are compelled to solve them using a variety of tools at your disposal (people, process, technology).
  • You have insatiable intellectual curiosity and enjoy figuring out how the pieces of a complex puzzle fit together, forming a deep understanding of the relevant details and translating that knowledge into systems-level solutions.
  • You value collaboration and feedback. You are willing and able to help your teammates grow by demonstrating best practices, giving/receiving respectful and constructive feedback, and sharing your unique insights with everyone.
  • You enjoy working in a fluid environment, defining and owning priorities that adapt to our larger goals. You can bring clarity to ambiguity while remaining open-minded to new information that might change your perspective.
  • You are not hesitant to jump in to help fix things that are broken and you feel a great responsibility to make sustainable systems and processes.
  • You are excited to rapidly expand your healthcare domain expertise, teach others what you know, and work with technology teams to develop high quality data products.

You should get in touch if:

  • You have 5+ years of work experience with at least 3 years spent working at a healthcare organization or a healthcare technology organization in a data intensive or technical role.
  • You should be very familiar with claims data, having a working knowledge of industry formats (837/835/HL7/FHIR) used when exchanging data and code sets (ICD10, HCPCS/CPT, DRG) relevant to claims.
  • You understand the nuances of claim adjudication systems, healthcare reimbursement practices (IPPS, OPPS, value-based models, risk adjustment), and how authorization or various clinical scenarios impact claims adjudication.
  • You are a strong communicator who can engage a wide variety of stakeholders.
  • You are fluent in SQL and maybe even have some engineering experience.
  • Bonus Points:
    • You have experience in defining data governance standards or working in data intensive operations.
    • You have experience with non-medical claims data (pharmacy, dental, vision).
    • You're familiar with other healthcare data domains and eager to tie the pieces together.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.

Clover Health welcomes qualified candidates with disabilities and will provide accommodations during the interview process as needed. If you require accommodations, please email [email protected] with the details of your requested accommodation. Requests are reviewed by a member of the recruiting team. Requests will have no bearing on the candidate evaluation process or hiring decisions.

About Clover Health

Clover Health is a data driven health insurance startup driving to improve the overall state of healthcare in America. We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road. Unlike other health insurance companies also embracing preventive health, Clover’s Medicare is built on technology from the ground-up. Integrating our systems with doctors, clinicians, and nurse practitioners, Clover’s data team helps healthcare professionals in the field intervene directly into patients’ wellness to help them avoid acute health episodes. If you’re a passionate person and interested in changing healthcare for the better, then Clover may just be the place for you.

Clover Health

Want to learn more about Clover Health? Visit Clover Health's website.