CMS Encounter Data Engineer

We don't just provide health insurance—we deliver the kind of healthcare that people deserve. The Risk Adjustment 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 Risk Adjustment team, helping ensure the accuracy, integrity, and performance of our encounter data and risk adjustment operations. Your work will directly influence revenue accuracy, compliance, and our ability to reinvest in better care for our members.

We're looking for a tech-savvy individual who is interested in enhancing Clover’s ability to make smart, data-driven business decisions to join our team. This person thrives at the intersection of engineering, analytics, and operations, and is motivated by solving complex data challenges in a highly regulated environment. You are energized by building scalable processes, improving data quality, and collaborating cross-functionally to drive measurable impact.

As a Senior Data Analyst, Risk Adjustment, you will:

• Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
• Own the claim and supplemental submission workflow for Centers for Medicare & Medicaid Services (CMS) Encounter Data System (EDS) submissions.
• Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors.
• Support the claim and supplemental submission workflow for CMS EDS submissions.
• Collaborate closely between the Engineering and Risk Adjustment teams.
• Assist with, track, and implement risk adjustment related initiatives and strategies.
• Maintain, update, and create policies, procedures, and other documentation around the encounter process.

Success in this role looks like:

• Within the first 90 days: You will develop a strong understanding of Clover’s end-to-end CMS EDS submission process, independently monitor data flows to vendors and CMS, identify and resolve encounter data errors, and build effective working relationships across Engineering and Risk Adjustment.
• Within the first 6 months: You will own the claim and supplemental submission workflow for CMS EDS submissions, proactively mitigate data leakage and submission errors, enhance tracking and reporting dashboards, and implement process improvements that strengthen data accuracy and operational efficiency.
• Future success: You will serve as a trusted technical partner to Risk Adjustment and Engineering, continuously optimize encounter data pipelines and controls, ensure high-quality and compliant CMS submissions, and drive scalable solutions that support accurate risk adjustment performance and business growth.

You should get in touch if:

• You have two years experience with Medicare Risk Adjustment, Centers for Medicare & Medicaid Services (CMS) Encounter Data System (EDS) submissions, and healthcare claims data.
• You have at least two years of programmers experience using SQL, Python, and R.
• You have experience with building operational level dashboards.
• You are a self-starter, have a high degree of internal drive and motivation, and desire to execute at a high level.
• You are relentlessly focused on serving the needs of diverse business customers.

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.
• 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.

Additional Perks:

• 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!

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, perspectives, opinions, 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.

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.