Data Scientist (BI) designing and implementing BI solutions for LUZA Group, focusing on data ingestion, transformation, analysis, and visualization, primarily with Power BI.
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
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Tech skills
Location requirements
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