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Actuary, Financial Intelligence & AI Innovation

1 hour, 57 minutes ago
United States
Full-time
Senior
Machine Learning Engineer
Artificial Intelligence and Machine Learning
Generative AI LLM Python SQL
Apply Now
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised
View All Jobs 38

Description

  • Lead AI strategy for financial performance by designing and deploying models that identify financial risks and opportunities across payer operations.
  • Partner with Payment Integrity teams to improve pre- and post-payment claims detection and automate fraud, waste, and abuse detection.
  • Develop predictive solutions that improve revenue accuracy and integrity, including encounter quality models and related financial data streams.
  • Build tools and models that help Actuarial and Medical Economics teams detect anomalies, utilization shifts, and provider behavior changes.
  • Translate ambiguous business questions from stakeholders into production-ready analytical and AI solutions.
  • Bridge domain knowledge and production implementation by connecting payer economics to technical solutions.
  • Support cross-functional teams including Actuarial, Payment Integrity, Product, Finance, and Medical Economics on enterprise initiatives.

Requirements

  • 5+ years of experience in a highly quantitative, hands-on role such as Actuarial Science, Healthcare Data Science, or ML Engineering.
  • Track record of shipping production-grade analytical or AI solutions.
  • Direct experience or exposure to health insurance economics, claims, and risk adjustment in Medicare Advantage, Medicaid, or ACA/Marketplace environments.
  • Experience with LLMs or Generative AI in healthcare or insurance workflows, with attention to explainability, auditability, and operational adoption.
  • High proficiency in Python and SQL.
  • Practical experience developing, deploying, and maintaining AI models in an operational environment.
  • Strong understanding of the financial and actuarial impact behind data anomalies and operational metrics.
  • Preferred experience working in government programs or payer economics contexts.
  • Preferred familiarity with building models for healthcare claims, billing irregularities, anomaly detection, or graph-based approaches.

Benefits

  • Competitive base salary of $165,000 to $220,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan with discounted shares.
  • Performance-based bonus program and regular compensation reviews.
  • 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Remote-first culture with flexibility to work from any location.
  • Generous flexible time-off policy, plus No-Meeting Fridays and monthly company holidays.
  • Professional development support, including learning programs, mentorship, and development funding.
  • Mental health resources and paid parental leave for all new parents.
  • Monthly cell phone and internet stipend, plus reimbursement for office setup expenses.

Interested in this position?

Apply directly on the company website

Apply Now

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