Senior Data Scientist

2 weeks ago

Mt Laurel, NJ, United States Compunnel Full time
Job Summary

We are seeking a Senior Data Scientist to support advanced analytics initiatives focused on Medicare Advantage.

This role is responsible for developing predictive models, enhancing risk adjustment accuracy, improving quality performance (including HEDIS and Star Ratings), optimizing member experience, and driving operational efficiency.

The ideal candidate will have deep expertise in healthcare data, statistical modeling, and machine learning, with the ability to translate analytical insights into meaningful business and clinical actions.

Key Responsibilities

1. Advanced Analytics & Modeling

  • Build, validate, and deploy predictive models related to:
  • Risk adjustment (RAF scoring, suspecting models)
  • HEDIS and Star Ratings performance
  • Member retention, engagement, and acquisition
  • Utilization prediction (hospitalizations, readmissions)
  • Fraud, waste, and abuse detection
  • Apply machine learning methods such as gradient boosting, random forests, NLP, and deep learning on large healthcare datasets.
2. Medicare Data Expertise
  • Work with key Medicare datasets including:
  • Medical and pharmacy claims
  • Encounter data
  • Eligibility and enrollment files
  • Provider data
  • CMS Stars and HEDIS datasets
  • Social Determinants of Health (SDoH)
  • Ensure all models and analyses comply with CMS guidelines and regulatory requirements.
3. Data Engineering & Pipeline Development
  • Collaborate with data engineering teams to build scalable, reliable data pipelines.
  • Use SQL, Python, and cloud technologies (AWS, Azure, GCP) to automate data workflows.
  • Conduct data quality checks and improve dataset reliability for modeling purposes.
4. Business Strategy & Decision Support
  • Translate analytical findings into actionable recommendations for:
  • Stars improvement initiatives
  • Care management and clinical operations
  • Risk adjustment and coding teams
  • Provider network and contracting teams
  • Present results and insights through dashboards, visualizations, and executive presentations.
5. Cross-Functional Collaboration
  • Partner with clinical SMEs, actuaries, product teams, and compliance professionals.
  • Lead analytics initiatives supporting Medicare Advantage growth and performance.
  • Mentor junior data scientists and help advance best practices across the team.
Required Qualifications
  • Bachelor's, Master's, or PhD in Data Science, Statistics, Computer Science, Public Health, or related field.
  • 5-8+ years of experience in data science or analytics.
  • Strong proficiency in Python, SQL, and machine learning libraries (scikit-learn, XGBoost, LightGBM).
  • Experience with Medicare Advantage, CMS regulations, Stars, or risk adjustment.
  • Hands-on experience working with cloud platforms (AWS, Azure, or GCP).
  • Strong communication and storytelling skills with the ability to interpret and present complex data effectively.
Preferred Qualifications
  • Experience with NLP and unstructured healthcare data.
  • Familiarity with Snowflake, Databricks, or Spark.
  • Experience building production ML models in healthcare.
  • Understanding of actuarial concepts and healthcare payment methodologies.
  • Prior experience improving Star Ratings or risk adjustment accuracy.

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