Health Data Scientist

Analytics Park Ridge, Illinois Opportunities available throughout U.S.


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.

Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals. All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.

Job Summary

Reporting directly to the Director of Analytics, as an associate data scientist you will be responsible for the successful delivery of the algorithms, statistical models, and reporting tools to meet business needs within clinical operations. Ensures data accuracy, integrity and completeness in the various internal and external data sources used for end-user reporting. Conduct highly complex quality management, procedural documentation and analysis on key data sets.

 

Main Responsibilities:

  • Manages large and complex analytical projects from data exploration, model building, performance evaluation and testing.
  • Complete complex SQL queries for data completeness as it relates to HEDIS, Risk Adjustment, Case Management, and Utilization Management.
  • Identifies new opportunities within historical data behaviors to help predict clinical operational process and workflow.
  • Performs analyses of structured and unstructured data to solve multiple and complex business problems. Utilizing advanced statistical techniques and mathematical analyses and specialized expertise in the organization and/or industry.
  • Help collaborate on the creation of medical management analytical and workflow project(s).
  • Lead in the creation of predictive analytics as it relates to membership adherence, medical management, and gap closures.
  • Work heavily with Power BI and other visualization tools
  • Help streamline member and provider scorecard data and create risk categorization to help manage sub-sets of population.
  • Advanced working knowledge writing SQL queries, with the ability to lead/participate in data mapping of various sources.
  • Respond to ad hoc reporting requests as needs arise, and work with all Company departments to identify and meet reporting requirements. Design, test, and execute to meet reporting needs working with business partners. Make recommendations to management/leadership based on business case and analysis.

Qualifications:

  • Bachelor degree in healthcare administration, systems/management information systems, mathematics or related health/IT field.
  • 5+ years of healthcare/medical field experience.
  • Minimum 3 years of predictive modelling and machine learning
  • Proven skill of multiple predictive work
  • Minimum 3+ years of work experience in healthcare and/or Medicare
  • Advanced SQL, Python, Power BI or Tableau and R experience
  • Experience in claim systems
  • Experience within Medicare advantage organization relating to Quality, medical management or risk adjustment.
  • Strong written and verbal communication skills with sufficient technical and operational capabilities to communicate with multiple teams at every level of the organization.
  • The ability to work independently and prioritize
  • Other duties as assigned.