Clover is building a next-generation financial intelligence capability that combines deep healthcare domain expertise with advanced AI/ML. We are seeking a high-level technical leader to serve as a strategic bridge across the enterprise—partnering with Actuarial, Payment Integrity, Product, Finance, and Medical Economics to optimize enterprise performance.
We are looking for a practitioner with a strong foundation in health insurance economics and government programs (Medicare Advantage, Medicaid, or ACA), who can apply AI/ML to the complex financial and operational levers that drive payer success.
The Role: Strategic Cross-Functional Leadership
In this role, you will act as a technical engine for Clover’s financial strategy. Rather than working in a silo, you will serve as a high-level lead, providing the AI/ML direction and technical support necessary to empower various disciplines across the organization. You will be the connective tissue between raw data and enterprise-level strategy, helping diverse teams identify financial risks, improve revenue accuracy, and build the analytical frameworks required to forecast and intervene with precision.
As an Actuary, Financial Intelligence & AI Innovation, you will:
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Lead AI Strategy for Financial Performance: Design and deploy high-impact AI/ML models that identify financial risks and opportunities across payer operations.
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Support Payment Integrity & FWA: Partner with the PI team to enhance in-house pre- and post-payment claims detection. Use ML, anomaly detection, and graph-based approaches to help teams identify billing irregularities and automate FWA detection.
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Advance Revenue Integrity: Create predictive solutions to improve revenue accuracy and integrity, including models for encounter quality and related financial data streams.
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Support Medical Cost Analysis: Build the tooling and models that help Actuarial and Medical Economics teams identify anomalies, unusual utilization patterns, or provider behavior shifts, providing the analytical backbone for precise intervention.
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Bridge Domain & Production: Operate as a hands-on leader who can frame ambiguous business questions from various stakeholders, connect them to underlying payer economics, and turn them into production-ready solutions.
You should get in touch if:
- You have 5+ years of experience in a highly quantitati