Senior Clinical Data Analyst
New
C
Clover HealthHealth Insurance
Remote - USAFull-TimeSenior
Salary$115,000 — $133,000 USD
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Job Details
- Experience
- 5+ years
- Required Skills
- SQLMicrosoft Power BITableauMicrosoft Excel
Requirements
- BA/BS in Mathematics, Statistics, Economics, Healthcare, or a related discipline.
- 5+ years of relevant professional experience.
- Strong SQL proficiency with experience querying, summarizing, and manipulating large healthcare datasets.
- Hands-on experience analyzing medical and pharmacy claims data (medical cost modeling, utilization analysis, trend analysis, PMPM calculations).
- Experience with healthcare actuarial concepts (risk adjustment methodologies like HCC/RAF, population risk stratification, enrollment/eligibility analysis).
- Knowledge of healthcare data standards and coding systems (ICD-10, CPT, DRG).
- Familiarity with healthcare quality measures (HEDIS, CMS, NCQA), preferably within Medicare Advantage.
- Ability to validate data quality, identify anomalies, document analytical assumptions, and perform member-level longitudinal analyses.
- Strong communication skills with experience presenting findings using tools such as Excel, Tableau, or Power BI.
Responsibilities
- Gather requirements from stakeholders and translate to specific and actionable work tasks.
- Develop complex SQL queries to support data-driven insights that inform business and clinical decisions.
- Analyze healthcare data (claims, lab, pharmacy and EMR data) to draw conclusions and provide consultation to stakeholders.
- Develop reports, dashboards, and visualizations that provide insights into various patient populations and health care utilization patterns.
- Partner closely with clinical and operational teams to ensure data-driven decision-making and assist in the assessment of treatment concordant care.
- Analyze CCS operations relative to goals and summarize the completion of routine tasks by various business unit resources.
- Ensure data accuracy, quality, and integrity when working across multiple data sets.
- Prepare and present findings and recommendations to leadership, internal clinical teams, and external stakeholders.
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