Senior Actuarial Analyst

Clover Health

4d•Remote

About The Position

We don't just provide health insurance—we deliver the kind of healthcare that people deserve. The Actuarial team at Clover is made up of collaborative and strategic thinkers who are excited about the impact technology can have on healthcare. We sit at the intersection of data, finance, and clinical strategy, translating complex insights into decisions that directly improve member outcomes and company performance. In this role, you will partner and help support a core area of responsibility for our Actuarial team, contributing to high-visibility work that informs revenue, pricing, and long-term growth strategy. We're looking for a tech-savvy actuarial analyst interested in enhancing Clover’s ability to make smart, data driven business decisions to join our team. You will work with large, complex healthcare datasets and leverage automation to improve accuracy, efficiency, and transparency across actuarial processes. This is an opportunity for someone who enjoys solving ambiguous problems, building scalable tools, and seeing their work directly influence financial and operational strategy. 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, perspectives, opinions, 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.

Requirements

At least one year experience in health insurance.
Completed at least two actuarial exams.
An interest in building automated tools around actuarial analysis and experience building analytic dashboards.
A self-starter, with a high degree of internal drive and motivation, and desire to execute at a high level.
Two years experience with Medicare Risk Adjustment, CMS EDS submissions, and healthcare claims data.
At least two years of programming experience. Examples include SQL, R, Python, SAS, VBA.

Nice To Haves

Medicare experience is preferred.

Responsibilities

Maintain internal CMS HCC and RxHCC models for calculating member level risk scores.
Support the monthly close process, including the development of actuarial risk adjusted revenue accruals and analysis of results.
Build reports to track ROI on various risk adjustment initiatives.
Support actuarial teams in the development of risk scores for forecast and bidding purposes.
Provide actuarial support on a wide variety of topics including risk adjustment, pricing, forecasting, reserving, trend analysis, and value-based care.
Communicate analysis, findings, and supporting data meaningfully to leadership and partnering teams.
Build automated actuarial tools and data pipelines.
Support compliance under Sarbanes Oxley, including through process and tool design, peer review and control testing.
Be accountable for key work products under the supervision of experienced actuaries.
Collaborate with internal departments, including but not limited to, Data Science, Finance, Actuarial, Operations, Provider Network Management, Engineering, and external vendors on risk adjustment activities.
Be eligible to participate in Clover's Actuarial Student Program.