Actuary, Financial Intelligence & AI Innovation

Clover is building a next-generation financial intelligence capability that combines deep healthcare domain expertise with advanced AI/ML. We are seeking a high-level technical leader to serve as a strategic bridge across the enterprise—partnering with Actuarial, Payment Integrity, Product, Finance, and Medical Economics to optimize enterprise performance.
We are looking for a practitioner with a strong foundation in health insurance economics and government programs (Medicare Advantage, Medicaid, or ACA), who can apply AI/ML to the complex financial and operational levers that drive payer success.

The Role: Strategic Cross-Functional Leadership
In this role, you will act as a technical engine for Clover’s financial strategy. Rather than working in a silo, you will serve as a high-level lead, providing the AI/ML direction and technical support necessary to empower various disciplines across the organization. You will be the connective tissue between raw data and enterprise-level strategy, helping diverse teams identify financial risks, improve revenue accuracy, and build the analytical frameworks required to forecast and intervene with precision.

• Lead AI Strategy for Financial Performance: Design and deploy high-impact AI/ML models that identify financial risks and opportunities across payer operations.
• Support Payment Integrity & FWA: Partner with the PI team to enhance in-house pre- and post-payment claims detection. Use ML, anomaly detection, and graph-based approaches to help teams identify billing irregularities and automate FWA detection.
• Advance Revenue Integrity: Create predictive solutions to improve revenue accuracy and integrity, including models for encounter quality and related financial data streams.
• Support Medical Cost Analysis: Build the tooling and models that help Actuarial and Medical Economics teams identify anomalies, unusual utilization patterns, or provider behavior shifts, providing the analytical backbone for precise intervention.
• Bridge Domain & Production: Operate as a hands-on leader who can frame ambiguous business questions from various stakeholders, connect them to underlying payer economics, and turn them into production-ready solutions.

• You have 5+ years of experience in a highly quantitative, hands-on role (Actuarial Science, Healthcare Data Science, or ML Engineering) with a track record of shipping production-grade analytical or AI solutions.
• You possess Government Programs Exposure: Direct experience or exposure to health insurance economics, claims, and risk adjustment within Medicare Advantage, Medicaid, or ACA/Marketplace environments.
• You have Modern AI Experience: Experience with LLMs or Generative AI in healthcare or insurance workflows, particularly where explainability, auditability, and operational adoption are critical.
• You are Technically Fluent: High proficiency in Python and SQL, with practical experience developing, deploying, and maintaining AI models in an operational environment.
• You possess Business Intuition: You understand the "why" behind the numbers—you can connect a data anomaly to its underlying financial or actuarial impact without needing a translator.

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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.