Data Science Engineer / Healthcare Data Analyst

About Us 

Zelis is modernizing the healthcare financial experience in the United States (U.S.) by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers in the U.S. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients.  

Why We Do What We Do 

In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.

Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture. 

Position Overview

Data Analyst with deep experience in the US Healthcare industry with the skills around ML

About Zelis

• Zelis is a leading payments company in healthcare, guiding, pricing, explaining, and paying for care on behalf of insurers and their members.
• We align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all.
• Partnering with 700+ payers, supporting 4 million+ providers and 100 million members across the healthcare industry.

About ZDI

Zelis Data Intelligence (ZDI) is a centralized data team that partners across Zelis business units to unlock the value of data through intelligence and AI solutions. Our mission is to transform data into a strategic and competitive asset by fostering collaboration and innovation.

• Enable the democratization and productization of data assets to drive insights and decision-making.
• Develop new data and product capabilities through advanced analytics and AI-driven solutions.
• Collaborate closely with business units and enterprise functions to maximize the impact of data.
• Leverage intelligence solutions to unlock efficiency, transparency, and value across the organization.

Key Responsibilities

• Conduct comprehensive data analysis using statistical and exploratory methods to uncover patterns and insights that drive data-driven decision-making in the US healthcare domain.
• Work with large datasets, including healthcare business unit (BU)-specific data such as claims, eligibility, provider networks, patient demographics, payments, and utilization trends.
• Leverage knowledge of healthcare industry metrics (e.g., HEDIS, CMS Star Ratings, risk adjustment models, and revenue cycle data) to optimize analytics strategies.
• Collaborate with data science and engineering teams to ensure data quality, availability, and reliability for AI/ML-driven healthcare analytics solutions.
• Design and maintain data pipelines for efficient ingestion, transformation, and storage of claims, electronic health records (EHR), HL7/FHIR data, and real-world evidence (RWE).
• Ensure compliance with HIPAA, PHI, and other regulatory requirements when handling healthcare datasets.
• Develop and maintain dashboards and reports that translate complex healthcare data into actionable insights for business stakeholders.
• Use visualization tools such as Streamlit over Snowflake, Power BI, or similar platforms to represent key healthcare metrics, trends, and performance indicators.
• Apply expertise in healthcare cost, quality, and operational performance analytics to deliver meaningful insights.
• Work closely with cross-functional teams, including data science, engineering, API development, and healthcare operations, to understand data needs and deliver tailored solutions.
• Partner with healthcare payers, providers, and revenue cycle management teams to enhance data quality and ensure alignment with industry standards.
• Actively engage with Data Science, Data Engineering, and Business Units to enhance process understanding and ensure data accuracy for regulatory and business reporting.
• Maintain a proactive mindset in exploring new analytical techniques, regulatory changes, and healthcare industry trends.
• Engage with industry experts, attend relevant healthcare and data science conferences, and contribute to continuous learning within the team.

Qualifications

• 5-8 years of hands-on experience in data analysis, preferably within the US healthcare domain, with exposure to payer, provider, claims, and financial data analytics.
• Strong proficiency in SQL and Python, including libraries such as pandas for data manipulation and analysis.
• Experience with healthcare data visualization and storytelling using tools such as Streamlit, Snowflake, Power BI, Tableau, or similar.
• Familiarity with ETL pipelines, data warehousing, and cloud platforms (AWS, Azure, GCP) for healthcare data processing.
• Deep understanding of US healthcare data, including claims, payments, eligibility, patient encounters, and provider networks.
• Strong knowledge of healthcare standards and regulations (HIPAA, PHI, HL7, FHIR, CMS, Medicare/Medicaid reporting, NCQA, HEDIS, and risk adjustment models).
• Experience in revenue cycle management (RCM), medical coding (ICD, CPT, DRG), and healthcare cost/utilization analytics is a plus.
• Ability to analyze complex healthcare datasets and derive meaningful insights that impact operational efficiency, patient outcomes, and cost optimization.
• Experience working with predictive modeling and AI-driven healthcare analytics is an advantage.
• Excellent communication and stakeholder management skills, with the ability to translate technical findings into business insights.
• Strong collaboration skills to work effectively with healthcare business teams, IT, and data science professionals.
• A curious mindset with a willingness to explore new challenges and drive innovation in healthcare analytics.