Full-Time

Data Analyst

Value-Based Care Analytics

Posted on 6/6/2026

Clover Health

Clover Health

501-1,000 employees

Medicare Advantage insurer with personalized care

Compensation Overview

$96k - $125k/yr

+ Bonus (Performance-based) + ESPP + 401k Matching

Remote in USA

Remote

Category
Data & Analytics (1)
Required Skills
BigQuery
SQL
Snowflake

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Requirements
  • Four or more years of hands-on healthcare data analytics experience, with direct exposure to payer or provider customers in a value-based care context.
  • Deep familiarity with value-based care metrics: risk adjustment including Hierarchical Condition Categories coding and RAF scores, utilization such as inpatient admissions, emergency department visits, readmissions, and cost metrics like per member per month, total cost of care, benchmark versus actual.
  • Strong Structured Query Language skills; able to write complex queries across claims, eligibility, and clinical datasets in cloud-based data warehouses such as Google BigQuery, Snowflake, or similar.
  • Exceptional data storytelling ability, translating analytical findings into clear narratives and visuals for clinical and non-technical audiences.
  • Experience building customer-facing reports and dashboards; comfortable presenting findings to external stakeholders including health plans, provider groups, Accountable Care Organizations.
Responsibilities
  • Build and maintain core Value-Based Care performance metrics across risk, quality, utilization, and cost domains, including HCC capture rates, RAF scores, PMPM trends, and inpatient/ED utilization rates.
  • Develop customer-facing analytics, reports, and dashboards that surface actionable performance insights for payer and provider partners in a clear, narrative-driven format.
  • Analyze Medicare Advantage performance data, including risk adjustment, quality bonus payments, and benchmark performance, to identify gaps, trends, and opportunities at the patient, provider, and market level.
  • Translate complex data findings into executive-ready narratives: written summaries, slide-ready visuals, and structured quarterly business review materials that tell a coherent story about performance and next steps.
  • Conduct deep-dive utilization and cost analyses, including high-cost claimant reviews, avoidable utilization patterns, and specialty/pharmacy spend trends, to identify levers for improvement.
  • Partner with Customer Success and Provider Operations teams to prepare and deliver performance reviews (quarterly business reviews, monthly reporting packages) that communicate value and surface priority action areas for each customer.
  • Collaborate with Data Engineering to validate claims and clinical data pipelines, flag anomalies, and ensure metric consistency across customer populations.
  • Contribute to the development of scalable analytics infrastructure: reusable SQL libraries, metric definitions, and documentation that enable the team to move faster.
Desired Qualifications
  • Medicare Advantage experience, including familiarity with CMS risk adjustment models (CMS-Hierarchical Condition Categories version 24/28), Star Ratings methodology, and MA quality bonus payment structures.
  • Familiarity with clinical terminologies: International Classification of Diseases 10th Revision, Current Procedural Terminology / Healthcare Common Procedural Coding System, National Drug Code, Systematized Nomenclature of Medicine Clinical Terms, Logical Observation Identifiers Names and Codes.
  • Experience using Python or R for data manipulation, cohort analysis, or statistical modeling.
  • Background working with Electronic Health Records or clinical data alongside claims (e.g., for care gap closure, chronic condition identification, or attribution logic).
  • Prior experience in a health plan, risk-bearing provider group, Accountable Care Organization, or health tech company supporting value-based care programs.

Clover Health provides Medicare Advantage plans for seniors in the United States, offering coverage that goes beyond traditional Medicare. Its services include personalized care, fitness memberships, home checkups, drug coverage, and Medigap insurance, with revenue coming from member premiums and Medicare reimbursements. The product works by enrolling members in Medicare Advantage and delivering added benefits through a network of healthcare providers and fitness centers, plus home visits and proactive support to manage health. The company differentiates itself with a focus on tailored, attentive care and a growing provider network to enhance member benefits, aiming to improve health outcomes. Its primary goal is to help seniors stay healthier and reduce out-of-pocket costs by combining comprehensive coverage with personalized services.

Company Size

501-1,000

Company Stage

IPO

Headquarters

Nashville, Tennessee

Founded

2014

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Simplify Jobs

Simplify's Take

What believers are saying

  • August 5, 2026 guidance rose to $2.92 billion-$3.0 billion revenue and $70-$85 million EBITDA.
  • Q2 2026 membership reached 157,309, up 48%, extending scale across core states.
  • A 4.5-star 2027 payment-year rating supports richer reimbursement and stronger retention.

What critics are saying

  • CMS appealed the July 2026 star-rating ruling; 2027 bonus payments now face reversal.
  • The July 4, 2026 breach exposed member PHI, triggering OCR, lawsuits, and monitoring costs.
  • Q4 2026 seasonal losses and an 86.5% claims ratio keep execution fragile.

What makes Clover Health unique

  • Clover Assistant turns claims data into physician prompts across Medicare Advantage visits.
  • Full-risk Medicare Advantage plus wide-network focus in New Jersey and Georgia differentiates Clover.
  • AI underwriting and home-visit operations combine clinical control with insurance economics.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

401(k) Company Match

Performance Bonus

Unlimited Paid Time Off

Remote Work Options

Parental Leave

Professional Development Budget

Phone/Internet Stipend

Growth & Insights and Company News

Headcount

6 month growth

0%

1 year growth

0%

2 year growth

-1%
Yahoo Finance
Aug 20th, 2026
Clover Health beats Q2 revenue estimates with 55.6% growth to $743M

Clover Health reported Q2 revenues of $743.2 million, up 55.6% year-on-year and exceeding analyst expectations by 2%. The Medicare Advantage provider also beat EPS estimates and issued full-year EBITDA guidance above analyst expectations. "Our results demonstrate that a wide-network, full-risk Medicare Advantage model can deliver better health outcomes, meaningful growth, and increasing profitability at the same time," said CEO Andrew Toy. The company's shares rose 1.9% following the results and currently trade at $4.22. This performance stood out amongst the 12 health insurance providers tracked, which collectively saw share prices fall 6.2% since their latest earnings despite revenues beating consensus estimates by 2.8%.

Yahoo Finance
Aug 14th, 2026
Clover Health beats Q2 estimates with $743M revenue, raises full-year guidance as AI platform drives growth

Clover Health reported second-quarter results that exceeded analyst expectations, with revenue of $743.2 million beating estimates by 2% and adjusted EBITDA of $40.92 million surpassing forecasts by 34.7%. The Medicare Advantage insurer's membership grew to 157,309, up from 155,773 in the previous quarter. CEO Andrew Toy attributed the performance to the company's Clover Assistant AI platform and disciplined market focus in New Jersey and Georgia. He emphasised that "better clinical care leads to stronger cohort economics." The company raised its full-year revenue guidance to $2.96 billion from $2.87 billion, a 3.3% increase. EBITDA guidance of $77.5 million exceeded analyst estimates of $58.44 million. Operating margin improved to 3.8%, up from negative 2.2% in the same quarter last year. Management credited favourable medical cost trends and improved operating leverage.

Yahoo Finance
Aug 13th, 2026
Clover Health grows MA membership 48% while boosting net income $67M in first half of 2026

Clover Health reported strong performance in the first half of 2026, with Medicare Advantage membership growing 48% and GAAP net income increasing by $67 million year-over-year. Chief executive officer Andrew Toy highlighted the company's focus on using AI to improve physician decision-making through its Clover Assistant platform. The earnings call, held on 5 August 2026, emphasised how technology-driven improvements in patient care can drive both membership growth and profitability simultaneously. Toy stated that Clover's approach centres on helping physicians make better decisions for individual patients, rather than simply making the healthcare system marginally more efficient. The results demonstrate the company's progress in scaling its AI-assisted healthcare model across its Medicare Advantage business.

Yahoo Finance
Aug 6th, 2026
Clover Health raises 2026 outlook as Medicare membership surges 48% to 157K

Clover Health reported strong second-quarter results, with Medicare Advantage membership rising 48% year-over-year to 157,000 and revenue growing 56% to $743 million. The company generated $41 million in adjusted EBITDA and $28 million in GAAP net income, ending the quarter with $443 million in cash and no debt. The health insurer raised its full-year 2026 outlook for membership, revenue, gross profit, adjusted EBITDA and GAAP net income. Management expects positive adjusted EBITDA in the third quarter but anticipates a seasonal loss in Q4. Consolidated gross profit reached $153 million, up 54% from last year. All members are now enrolled in plans rated 4.5 stars for the 2027 payment year, though the Centers for Medicare & Medicaid Services plans to appeal the related court decision.

Yahoo Finance
Aug 5th, 2026
Clover Health revenue jumps 55.6% to $743M, beats Q2 estimates and raises full-year guidance

Clover Health reported second-quarter revenue of $743.2 million, beating analyst estimates of $728.2 million and marking 55.6% year-on-year growth. The health insurance company's shares rose 10.3% following the announcement. The company posted GAAP earnings of $0.05 per share, surpassing consensus estimates of $0.03. Adjusted EBITDA reached $40.92 million, exceeding expectations of $30.38 million by 34.7%. Clover Health raised its full-year revenue guidance to $2.96 billion at the midpoint, up from $2.87 billion previously. Full-year EBITDA guidance of $77.5 million also came in above analyst estimates of $58.44 million. The company's customer base grew to 157,309, up from 155,773 in the previous quarter. Operating margin improved to 3.8%, compared with negative 2.2% in the same period last year.

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