Hybrid Senior Data Scientist – MRA

at Elevance Health

• Job title: Senior Data Scientist – MRA
• Job type: Full Time
• Experience level: Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Tech skills: Python, SQL, Tableau
• Location requirements: Hybrid, Atlanta, United States

About the role

• Data Scientist Senior developing predictive models and analytics in healthcare domain. Collaborating with cross-functional teams to improve compliance and data quality with advanced technologies.

Responsibilities

• Develops predictive models and performs statistical analyses using Python, R, or SAS to identify trends, detect anomalies, and inform compliance strategy
• Designs and implements automated tools to support ongoing monitoring of compliance and risk adjustment metrics
• Applies machine learning and NLP methods to various structured and unstructured data across Medicare, Medicaid, and Commercial programs
• Writes and optimizes complex SQL queries to extract and analyze large datasets from various sources
• Investigates data patterns, discrepancies, and trends to support regulatory reporting and internal audits
• Partners with Risk Adjustment teams to ensure data quality and identify gaps in submissions for all three lines of business
• Assesses the risk and operational impact of new or updated CMS, state Medicaid, or commercial regulations and policies
• Provides data-driven insights to improve internal controls and drive proactive compliance strategies
• Collaborates cross-functionally with Legal, Quality, Operations, and IT teams to evaluate processes and support mitigation plans across lines of business
• Designs and leads predictive modeling projects to address more complex business problems determined by consultation with business partners
• Recommends appropriate batch and real-time model scoring to drive actions
• Provides oversight in development of proprietary algorithms to build customized solutions
• Develops advanced visualization of analysis output for business users
• Publishes results and addresses constraints/limitations with business partners
• Provides actionable insights to output produced to ensure established targets are met
• Determines the continuous improvement opportunities of current predictive modeling algorithms
• Collaborates with business partners to determine identified population segments and develop actionable plans to enable the identification of patterns related to quality, use, cost and other variables
• Mentors other data scientists

Requirements

• Requires a Bachelor’s Degree in Statistics, Computer Science, Mathematics, Machine Learning, Econometrics, Physics, Biostatistics or related Quantitative disciplines
• 5 or more years of experience in predictive analytics or equivalent
• Proficiency in Python, R, or SAS for statistical analysis and data modeling highly preferred
• Advanced SQL skills with experience in querying large, complex healthcare datasets highly preferred
• Working knowledge of Risk Adjustment methodologies (e.g., HCC, CDPS) and applicable Medicare, Medicaid, and Commercial regulations highly preferred
• Solid understanding of healthcare regulations (specifically Risk Adjustment)
• Experience leading end-to-end data science project implementation highly preferred
• Experience supporting multiple lines of business within a health plan environment preferred
• Familiarity with healthcare compliance audits and regulatory submissions preferred
• Proficiency in data visualization tools such as Tableau or Power BI preferred
• Ability to explain complex technical and regulatory concepts to non-technical audiences preferred
• Experience managing a small team either through formal or informal reporting relationship preferred
• PhD and experience in the healthcare sector preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources