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Clover Health

Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.

Risk Adjustment Actuary
United States of America
Job Description / Skills Required

Clover is reinventing health insurance by working to keep people healthier.

We don't just provide health insurance—we deliver the kind of healthcare that people deserve. The Actuarial team at Clover is made up of collaborative and strategic thinkers who are excited about the impact technology can have on healthcare. In this role, you will partner and help support a core area of responsibility for our Actuarial team.

As a an Actuary you will: 

  • Support the monthly close process, including the development of actuarial risk adjusted revenue accruals and analysis of results.
  • Oversee and maintain internal CMS HCC and RxHCC models for calculating member level risk scores.
  • Builds reports to track ROI on various risk adjustment initiatives.
  • Support actuarial teams in the development of risk scores for forecast and bidding purposes.
  • Provide analytical support in the optimization of risk adjustment related activities while maintaining compliance with CMS standards.
  • Collaborates with internal departments, including but not limited to, Data Science, Finance, Actuarial, Operations, Network Management, and external vendors on risk adjustment activities. 

You will love this job if:

  • You are passionate about your career in actuarial science and want to demonstrate the value that actuaries can provide in a highly collaborative and cross-functional environment.
  • You dream about ways to make the healthcare system more efficient and are excited about the prospect of leveraging modern tools and  techniques to do so.
  • You are analytical and strategic and love working in a collaborative, transparent work environment.
  • You want to make an impact. From project scope to priority to implementation, you'll have an impact on how decisions get made.

You should get in touch if:

  • You have achieved, or are near to achieving, the ASA credential
  • You have at least three years of experience in health insurance; Medicare experience is preferred.
  • You have an interest in building automated tools around actuarial analysis.
  • You have basic programming skills, such as SQL, SAS, R, or Python.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

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.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.