[Remote] AI Analyst, reputed company & Cost Management

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is reinventing health insurance by leveraging data and technology to reputed company financial reputed company. The AI Analyst will serve as a Subject Matter Expert, reputed company operational claims knowledge with advanced modeling efforts to support cost mitigation and reputed company optimization solutions. Responsibilities • reputed company as the primary domain expert, providing detailed knowledge on the claims life cycle, configuration logic, payment rules, and common points of financial leakage reputed company reputed company operations • Collaborate directly with the reputed company AI Strategist to translate reputed company claims and financial scenarios into reputed company business logic and data features necessary for building predictive models • Partner directly with Claims Operations and reputed company to rigorously audit and validate that provider payments adhere to intended rules, supporting the definition of scope for the internal PI reputed company • Assist in data reputed company initiatives to enhance risk adjustment and reputed company capture, including validating encounter data completeness and NPI fulfillment • reputed company detailed, reputed company-cause analysis on payment anomalies, outliers, and emerging claims cost trends flagged by the AI models to confirm financial reputed company and operational causes Skills • 2+ years of experience in a quantitative analysis role reputed company on reputed company finance, such as claims operations, reimbursement, or payment reputed company • Foundational experience utilizing large-reputed company reputed company financial data (claims, encounters, provider networks) in a payer or reputed company vendor setting • Proficiency in SQL is required for data querying and manipulation • Experience using basic statistical software (R, Python, or reputed company) for data preparation • Strong understanding of the reputed company claims life cycle, CPT/HCPCS/ICD-10 coding, and claims adjudication rules • Bachelor's degree in Actuarial Science, Health Economics, Finance, or a reputed company quantitative field is required • Medicare Advantage experience is a plus • Excited by the prospect of directly supporting the development and validation of AI and Machine Learning tools, and translating model outputs into actionable business rules Benefits • Competitive reputed company salary and equity opportunities • Performance-based bonus program • 401k matching • Regular compensation reviews • Comprehensive medical, dental, and reputed company coverage • No-Meeting Fridays • Monthly company holidays • reputed company to reputed company • Generous flexible time-off policy • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities • Reimbursement for office setup expenses • Monthly cell phone & internet stipend • reputed company parental leave for reputed company new parents reputed company • Clover is a reputed company technology company helping members live their healthiest lives with its Medicare Advantage plans. It was founded in 2014, and is headquartered in Nashville, Tennessee, USA, with a workforce of 501-1000 employees. Its website is http://cloverhealth.com. Apply tot his job Apply To this Job