HEDIS Operations Analyst at Clover Health
San Francisco, CA, US
Clover is reinventing health insurance by working to keep people healthier.

The Clinical Data Operations team is a motivated, collaborative team sitting at the intersection of Clover's member care operations, data infrastructure, and software. As operational owners of incoming data on our members' healthcare, we are responsible for retrieving, processing, and reporting this clinical information, both to the rest of the company and the federal government. Come join us as we discover new opportunities to capture, manage, and share data in order to provide the best possible care to our members.

As a HEDIS Operations Analyst , you will play a critical role in ensuring that Clover maintains a high-quality clinical data pipeline. You will work with many teams across Clover, collaborating together to improve processes and address operational issues. You'll be joining a fast-growing and fast-moving startup at the intersection of the healthcare and technology industries, where you'll have the opportunity to develop both your analytical and operational skills.

Your main focus will be to support the HEDIS Audit and Submission process. The Healthcare Effectiveness Data and Information Set (HEDIS) is a standard tool used by health plans to monitor the quality of care and service they provide to their members. HEDIS performance also heavily influences the Medicare Star Rating assigned to Clover.

As a HEDIS Operations Analyst, you will:

Be responsible for Clover's data pipeline for HEDIS; including data quality, pipeline structure, and reporting.
Digest complex data concepts and communicate them effectively to different stakeholders.
Partner with Clover's HEDIS experts to develop a deep understanding of the technical specifications and software vendor requirements necessary to generate the data files used in reporting and develop these files.
Perform deep analysis on gnarly data sets to identify improvements to the pipeline and/or operations, and work closely with data scientists, engineers, and operational teams to create sustainable and scalable solutions.
Become a clinical data expert, and use this knowledge to connect with other Clover teams and share your insights.
Implement and document the process for the transformation of data from its original source to the software vendor's data types.
Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration.

You will love this job if:

You want to make an impact. You thrive off of helping others and want your work to make a difference in our members' lives.
You are a team player. You enjoy partnering with others and want to work collaboratively to find new solutions.
You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.
You have a critical and analytical mindset. You want to understand how all the pieces of a process fit together and quantify the contribution of each component.
You are motivated to learn. There is no shortage of technical, clinical, and operational skills to learn at Clover.
You are curious. You like to do research when you don't know an answer. You ask the hard questions and you don't sweep problems under the rug.
You are organized. You can prioritize your work, and weigh trade-offs on your own.
You are nimble, and comfortable working in a constantly evolving environment.

You should get in touch if:

You have 3+ years of work experience.
You have 2+ years writing complex SQL queries.
HEDIS experience preferred but not required.
You are excited about healthcare, and eager to understand how it can be impacted by technology.
You enjoy putting your critical thinking skills to the test.
You like to quantify things.
You have a history of meticulous work, and strive for accuracy and efficiency.
You enjoy working in teams and helping others, while also having the ability to work autonomously.
You are a problem solver, and love to learn!