Operational Analytics Associate, Claims

Clover Health, San Francisco, CA

Clover is a Medicare Plan done differently.

Clover is reinventing health insurance to keep people healthier.

As an Operational Analyst Associate within the Claims team, you will build domain knowledge and work cross-functionally with both operations and our technical teams to improve claims adjudication, monitoring, audit preparation, and quality accuracy. You will collaborate with other Operational Analysts across Operations at Clover to bring best practice and new insights to the Claims team. You will be joining a fast-growing and fast-moving startup at the intersection of the healthcare and technology industries, where you will have the opportunity to develop both your analytical and operational skills.

The Claims team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of insurance operations. This team maintains the business function of any claims related activities, including claims monitoring, payment disputes, escalated provider inquiries, and claims system configuration. The team also works on projects to improve the efficiency and accuracy of its own operations. The success of insurance operations relies on collaboration with our internal counterparts: Membership, Utilization Management, Appeals, Grievances, Customer Service, and Provider Data.

As an Operational Analytics Associate, you will:

  • Embed in the Claims Operations team to develop a deep understanding of operations and compliance related to claims processing.
  • Partner with Product Managers and Data Engineers to develop tools and automation to improve team efficiency and innovate on how claims are monitored and reviewed.
  • Develop an understanding of underlying data flow and models then extend workflows with new data streams and tooling.
  • Develop and report on key business metrics related to claims including overall quality, timeliness, medical expense and individual productivity metrics.
  • Perform root cause analyses, proactively identify trends, and forecast claims volume and required staffing.
  • Work with ambiguity and speed with a bias towards action.
  • In collaboration with Operations Leads, provide consult to Data Science, Engineering, Design, and Product for business decisions.

You will love this job if:

  • You have a system level and analytical mindset. You understand how all the components of a process fit together and believe in data-driven policy and process improvements.
  • You love working with data and have strong data analytic skills.
  • You are humble and understand that as a subject matter expert, you are there to serve and support to ensure that team members have the information they need for success.
  • You are a team player. You enjoy partnering with others and want to work collaboratively to find new solutions.
  • You are nimble, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action.
  • You are excited by the opportunity to also support and bring structure to content that drives the company.

You should get in touch if:

  • You have 4+ years of prior work experience plus a proven background in analyzing data, ideally using SQL, to guide and develop business operations and decisions.
  • You are a clear and concise communicator and know how to tailor your message to your audience.
  • You have worked at an intersection of healthcare and operations (preferred).
  • You have worked with claims previously (preferred).

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.

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.