Senior Clinical Data Analyst

Clover Health

3h•Remote

About The Position

The Clover Care Services organization delivers proactive support and care to our members through our Clover Home Care teams, and quality improvement services to our aligned insurance plan providers through our practice engagement team. We have built one of the most proactive, data-driven health care services platforms in New Jersey and are excited about the future of technology and how it impacts our ability to bring transformative results to both patients and providers. As a Senior Clinical Data Analyst in the Clover Care Services (CCS) organization, you will help drive better patient outcomes, improve care coordination, and optimize resource utilization by providing actionable insights to health care providers, practice administrators and CCS leadership. In this role you will be called upon to develop dashboards that measure external provider performance, generate population health management insights as well as respond to data requests that provide an operational perspective relative to business unit OKRs. The right person must be a data-driven, highly analytical problem-solver with exceptional organizational skills, and passionate about our mission. Clover is reinventing health insurance by combining the power of data with human empathy to keep members healthier. They believe the healthcare system is broken and have created custom software and analytics to empower clinical staff to intervene and provide personalized care. The company prioritizes its members, measuring team success by the quality of life of the people they serve. Clover employees are passionate, mission-driven individuals with diverse expertise, working together to solve healthcare challenges. Diversity & Inclusion are key to their success, embracing people with different strengths, experiences, and backgrounds who share a passion for improving lives. Diversity includes race, gender identity, age, disability status, veteran status, sexual orientation, religion, and other aspects of identity, with all employee points of view being crucial for success and inclusion being everyone's responsibility.

Requirements

BA/BS in Mathematics, Statistics, Economics, Healthcare, or a related discipline, with 5+ years of relevant professional experience.
Strong SQL proficiency with experience querying, summarizing, and manipulating large healthcare datasets.
Hands-on experience analyzing medical and pharmacy claims data, including medical cost modeling, utilization analysis, trend analysis, and PMPM calculations.
Experience with healthcare actuarial concepts, including risk adjustment methodologies (e.g., HCC, RAF), population risk stratification, and enrollment/eligibility analysis.
Knowledge of healthcare data standards and coding systems (ICD-10, CPT, DRG) and familiarity with healthcare quality measures (e.g., HEDIS, CMS, NCQA), preferably within Medicare Advantage.
Ability to validate data quality, identify anomalies, document analytical assumptions, and perform member-level longitudinal analyses.
Strong communication skills with the ability to translate complex analytical findings into clear, actionable insights and present them to actuarial, clinical, financial, and operational stakeholders using tools such as Excel and data visualization platforms (e.g., Tableau, Power BI).

Responsibilities

Gather requirements from stakeholders and translate to specific and actionable work tasks.
Develop complex SQL queries to support data-driven insights that inform business and clinical decisions.
Analyze healthcare data (claims, lab, pharmacy and EMR data) to draw conclusions and provide consultation to stakeholders for use in administering specific programs and operational processes.
Develop reports, dashboards, and visualizations that provide insights into various patient populations and health care utilization patterns.
Partner closely with clinical and operational teams to ensure data-driven decision-making and assist in the assessment of treatment concordant care.
Analyze CCS operations relative to goals and summarize the completion of routine tasks by various business unit resources.
Ensure data accuracy, quality, and integrity when working across multiple data sets.
Prepare and present findings and recommendations to leadership, internal clinical teams, and external stakeholders in support of Clover Care Services business initiatives.