Healthcare Navigation Data Scientist

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Analyze healthcare and book-of-business data to pinpoint cost drivers, utilization patterns, and opportunities for enhancing member outcomes while minimizing healthcare expenses.

• Develop and refine methodologies for provider scoring, ranking, and recommendations, incorporating factors such as cost, quality, specialty alignment, and provider experience.

• Integrate and transform claims, provider, pricing, and network data for analytical and modeling projects.

• Construct, validate, and optimize statistical, predictive, and machine learning models to enhance the relevance and personalization of provider searches.

• Assess business rules, scoring outputs, and recommendation effectiveness against clinical and business goals.

• Track key performance indicators and suggest improvements to data sources, models, and processes.

• Collaborate with Product, Engineering, Clinical, Value Engineering, and Business teams to convert insights into actionable solutions and measurable value.

• Improve provider search, recommendation, and value measurement functionalities across the Health Navigation platform.

⛳️ Requirements

• Experience in handling large, complex datasets utilizing SQL and Python and/or R.

• Proven experience in developing data models, scoring frameworks, predictive analytics, or machine learning solutions.

• Familiarity with healthcare datasets and concepts, including claims data, CPT, ICD, NPI, provider networks, and healthcare pricing.

• Comprehension of healthcare cost drivers, utilization analytics, quality measures, and provider performance metrics.

• Strong analytical, problem-solving, and communication skills to convey complex findings as business insights.

• Experience with provider search, recommendation systems, ranking models, or personalization algorithms.

• Knowledge of clinical quality measures such as HEDIS, CMS, or other related healthcare standards.

• Experience in applying machine learning techniques within healthcare, health technology, or navigation settings.

• Bachelor’s degree in data science, Statistics, Mathematics, Computer Science, Healthcare Analytics, or a related discipline.

• Applicants must reside in one of the 50 United States or the District of Columbia.

• Proof of US citizenship is required at the time of hire.

• Must possess work authorization that does not currently or in the future require visa sponsorship.

• Successful completion of a background check is mandatory if employment is offered.

• Virtual interviews must be conducted via video.

🏝️ Benefits

• Health, dental, and vision coverages commencing on Day One.

• Wellbeing programs.

• Retirement plans with contribution matching.

• Generous time off.

• Parental leave.

• Opportunities for continuing education.

• Career advancement opportunities.

• Flexible working arrangements whenever feasible.

• Competitive total rewards package.

• Ongoing education and training.

• Occasional travel to physical office locations may be necessary.