Summary:
In this role, you will develop analytical models to identify payment anomalies in client’s healthcare claims data (fraud, waste, or abuse). The results from your work will be reviewed by clinical analysts for outcome success. To be successful in the role, you will have sound knowledge and experience Statistical Models, Data Mining, Machine Learning, building analytical solutions to deliver insights, insights communication and presentation, as well as demonstrating the ability to combine advanced analytics skills with exceptional business acumen.
Responsibilities
- Develop a deep understanding of the key initiative of the organization and be able to provide analytical solutions that provides actionable recommendations to drive the success of the key initiatives
- Lead the development of analytical models for new and ongoing product lines
- On-going monitoring of product lines including but not limited to the success metrics for each model and dashboards required for executive decision-making
- Develop analytical insights for the customer’s healthcare information
- Assist in the accurate and timely preparation of management tools for analyzing clinical, and operational results using enterprise tools
- Serve as an additional point of contact and resource for analytics
- Prepare on-demand analyses and ad-hoc reports and insights
- Research and keep current knowledge of competitive methods in the competitive space
- Capable of applying the latest technologies and methodologies in machine learning, data mining, and predictive analytics to correlate disparate datasets and events, and derive value
- Has a proven ability to learn quickly and works well both independently as well as in a team setting
- Communicate analytical findings and recommendations in a clear and concise way to non-technical audiences, both in oral and written presentations
- Work closely with Information Management teams to automate recurring tasks and improve processes to continually increase efficiency
Qualifications
- Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance or related field. Master’s degree preferred
- 7+ years of experience in healthcare analytics, creating strategic plans, and operationalizing functional teams in direct relation to meeting business needs or realizing goals tied to strategic objectives
- Experience in strategic planning and solutioning preferred. Broad exposure and understanding of statistical, analytical, or data mining techniques and appropriate application of these capabilities in a business performance environment preferred
- Working knowledge of analytical tools, including R, Python, SAS, Tableau, Hadoop, or related tools preferred
- SQL programming
- Understanding of healthcare claims adjudication and claims content preferred
- Experience with report/dashboard development, data/report automation, self-service capabilities, data design and integration, or data quality and governance preferred
- Experience working in the healthcare setting and utilizing healthcare data to generate insights
- Demonstrate good understanding of healthcare data analytics terminology and concept, e.g., ICD, CPT, REV, DRG, etc.
- Must have demonstrated the ability to solve complex problems with minimal direction
- Experienced with languages used to manipulate data and draw insights from large data sets (e.g., Python, R, SQL, etc.)
Primary Location: 4965 Preston Park Blvd, 350, Plano, TX 75093
Job Type: full-time, hybrid
Job Title: Senior Data Scientist
Salary: $120,000+ per year, based on experience
Benefits:
- Health insurance
- Performance bonus
- Paid time off
- 401K
Schedule:
- Monday to Friday, 9-5
- Hybrid work (2 days in the office)
