Data Scientist Senior (MRA)
Location: This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. ? Ideal candidates will be able to report to one of our Pulse Point locations in Norfolk, VA, Mason, OH, Atlanta, GA, Wallingford, CT or Indianapolis, IN. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Data Scientist Senior (MRA) is responsible for the development and implementation of predictive modeling algorithms and techniques to solve more complex business problems and optimize member experiences specifically working with data science, healthcare analytics, and compliance oversight supporting Medicare, Medicaid, and Commercial lines of business.
How you will make an impact:
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, including claims, encounters, finance, remit/return files, etc.
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 that go beyond standard industry tools and lead to innovative solutions.
Develops advanced visualization of analysis output for business users.
Publishes results and address 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.
Minimum Requirements:
Requires a Bachelor's Degree in Statistics, Computer Science, Mathematics, Machine Learning, Econometrics, Physics, Biostatistics or related Quantitative disciplines and 5 or more years of experience in predictive analytics or equivalent, or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
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), and the critical thinking ability to assess risks and interpret the operational impact of policy and process changes highly preferred.
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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
