AI Strategist, Revenue & Cost Management

Clover is reinventing health insurance by working to keep people healthier. The Actuarial organization at Clover is driving a strategic transformation by leveraging AI to move from reactive analysis to proactive, predictive financial control. We are seeking a visionary technical leader to design and deploy the AI models foundational to this strategy.

As the Lead AI Strategist, you will be the primary technical leader responsible for the research, design, and implementation of advanced AI/ML models targeting enterprise financial performance. Your work will directly impact revenue optimization (Risk Adjustment) and medical cost mitigation (Claims Integrity), delivering high-ROI solutions and establishing a strong in-house financial control capability.

As the lead AI Strategist, you will:

• Develop Core AI Models: Lead the design and deployment of high-impact machine learning models (e.g., anomaly detection, graph analytics, time-series forecasting) focused on identifying and mitigating financial loss across the organization.
• Internal Payment Integrity (PI): Pioneer the technical strategy to build and deploy an in-house pre- and post-payment claims detection engine, combining AI and graph analytics to reduce vendor dependency and improve recovery efforts.
• Claims Cost Trend Analysis: Design models to proactively detect emerging claims cost trends and outliers, providing early warnings to the Chief Actuary on potential medical expense inflation.
• Revenue Optimization: Develop predictive analytics to advance risk adjustment and data quality initiatives, including encounter analysis and demographic data enrichment.
• Strategic R&D: Deconstruct and reverse-engineer external vendor pricing logic and claims edit systems to build scalable, transparent, and superior internal models.

You should get in touch if:

• You have 4+ years of experience in a quantitative, hands-on role (including Data Science, ML Engineering, or Actuarial Science) where you have successfully designed and delivered production AI solutions to solve mission-critical business problems.
• You have 4+ years of deep domain experience utilizing large-scale healthcare financial data (claims, encounters, provider networks) in a payer setting.
• You have Expert-level fluency in Python and SQL is required, along with practical experience implementing and maintaining Machine Learning (ML) and Artificial Intelligence (AI) models in a robust operational environment.

Benefits Overview:

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!

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.