Lead Data Scientist
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Job Description
Lead Data Scientist developing policy-adherence metrics and valuation models for Humana’s healthcare and insurance operations. Transforming complex claims-related data into actionable compliance and network insights.
Responsibilities:
- Transform high volumes of complex data into advanced analytic solutions using mathematics, statistics, modeling, business analysis, and technology
- Develop, maintain, and collect structured and unstructured data sets for analysis and reporting
- Create reports, projections, models, and presentations to support business strategy and tactics
- Advise executives on significant, often segment-specific, functional strategies
- Shape strategy for innovative analytics solutions providing actionable insights into policy adherence, compliance, operational consistency, and decision-making
- Research, design, and implement a policy adherence metric using FRAC and PA denials information and advanced data modeling
- Design valuation models to measure savings from removing non-compliant outliers
- Partner with National BH, Contracting, Medicaid, and ND&PPS teams to support operational use of the metric, including MHPAEA and Humana policy compliance
- Shape future measurement of ancillary/inpatient psychiatric provider types and other opportunity areas
- Manage stakeholders and expectations across data source owners, compliance, policy/governance, business, PTC, and National program partners
- Influence priorities, tradeoffs, and roadmap decisions while implementing a scalable solution
Requirements:
- Master's Degree
- Minimum 8 years of professional experience in data and analytics transforming data sets for actionable insights and reporting
- Minimum 5 years of experience utilizing SQL
- Minimum 4 years of project leadership experience
- Experience using mathematics, statistics, modeling/Machine Learning modeling, business analysis, and technology to transform high volumes of complex data into advanced analytic solutions
- Demonstrated experience working on problems of diverse scope and complexity ranging from moderate to substantial
- Experience developing, maintaining, and collecting structured and unstructured data sets for analysis and reporting
- Experience creating reports, projections, models, and presentations to support business
- Ability to exercise independent judgment and decision making on complex issues
- Ability to work under minimal supervision using independent judgment
- Minimum download speed of 25 Mbps and upload speed of 10 Mbps
- Wireless, wired cable, or DSL connection suggested; satellite, cellular, and microwave connections require leadership approval
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
- Preferred: Doctorate degree
- Preferred: Experience with claims datasets
- Preferred: Experience with Databricks
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Home or Hybrid Home/Office telephone equipment
- Bi-weekly internet expense payment for associates living and working from home in California, Illinois, Montana, or South Dakota
- Occasional travel to Humana offices for training or meetings
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