Clover Health · 1 month ago
AI Strategist, Revenue & Cost Management
United States
Full-time
Remote
Mid, Senior Level
$200K/yr - $230K/yr
4+ years expClover Health is reinventing health insurance by leveraging AI to enhance financial control and improve healthcare outcomes. The Lead AI Strategist will be responsible for designing and implementing advanced AI/ML models to optimize revenue and mitigate medical costs, directly impacting the organization's financial performance.
Health CareHealth InsuranceHospitalMedical
Responsibilities
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
Qualification
Required
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
4+ years of deep domain experience utilizing large-scale healthcare financial data (claims, encounters, provider networks) in a payer setting
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
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.
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!
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
H1B Sponsorship
Clover Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
Fierce Healthcare
2026-01-19
2026-01-16
Company data provided by crunchbase