Health Plan Data Scientist
Long Beach Office 3800, United States
USD 106K-182K Mid-level Full Time
Tasks
- Analyze network and contracting unit cost provider relativity site of service shift
- Analyze utilization management and medical policy opportunities
- Apply data science methods to healthcare data
- Assess payment integrity coding billing and payment accuracy
- Build predictive models for clinical programs
- Communicate savings opportunity sizing to business stakeholders
- Create analysis requirements test and validate findings
- Evaluate benefit design and coordination of benefits recovery
- Identify total cost of care savings opportunities
- Measure supplemental program utilization cost and ROI
- Shape medical economics analytics and AI strategy
- Support opportunity tracking through implementation
- Synthesize claims clinical and contract data using GenAI
Perks/Benefits
- 401k employer match
- Employee bonus program
- Employee recognition program
- Paid Holidays
- Paid time off
- Tuition reimbursement
- Volunteer days
- Wellness program
Skills/Tech-stack
Agile | Azure DevOps | CPT/HCPCS | Coordination of Benefits | DRG validation | Databricks | Embeddings | Generative AI | HCC RAF | HCC RAF Risk Adjustment | IBNR | ICD-10 | LLM | Langchain | Langgraph | Language Processing | MLOps | MLflow | Machine Learning | Medicare Advantage | Mlr | Monitoring and Alerting | Natural Language | Natural Language Processing | PMPM | Power BI | Python | R | Retrieval-Augmented Generation | Risk adjustment | SQL | Scrum | Segmentation Analysis | Snowflake | Statistical modeling | Streamlit | Tableau | Trend analysis | Vector Databases
Education
Bachelor of Engineering | Bachelor of Science | Master of Science
Roles
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