Note: The job is a remote job and is open to candidates in USA. Humana is a healthcare company providing insurance and healthcare services. The Lead Data Scientist transforms complex structured and unstructured data into advanced analytic solutions, develops models and reports, and advises executives on business strategies. The role focuses on creating policy adherence metrics, valuation models, and scalable analytics solutions while collaborating with stakeholders across compliance, policy, governance, and business teams.
Responsibilities
- The Lead Data Scientist uses mathematics, statistics, modeling, business analysis, and technology to transform high volumes of complex data into advanced analytic solutions
- The Lead Data Scientist develops, maintains, and collects structured and unstructured data sets for analysis and reporting
- This individual will create reports, projections, models, and presentations to support business strategy and tactics
- The Lead will advise executives to develop functional strategies (often segment specific) on matters of significance
- Being a thought partner in shaping the strategy for innovative analytics solutions that provide actionable insights into policy adherence, enabling improved compliance, operational consistency, and decision-making
- Researching, designing, and implementing a policy adherence metric rooted in FRAC and PA denials information using advanced data modeling techniques
- Designing valuation model(s) to measure savings tied to removing outliers who are non-compliant with the policy adherence metric
- Partnering with National BH/Contracting/Medicaid/ND&PPS teams to support use of this metric in operations including compliance with MHPAEA and other HUM policies
- Shaping the path to measuring ancillary / inpatient psychiatric provider types and/or other opportunity areas in the future
- Managing stakeholders/expectations while working across different teams including data source owners, compliance, policy/governance, business, PTC/National program partners
- Influencing priorities, tradeoffs, roadmap decisions in driving the implementation of a scalable solution
Skills
- 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 in using mathematics, statistics, modeling/Machine Learning modeling, business analysis, and technology to transform high volumes of complex data into advanced analytic solutions
- Successful demonstrated experience in working on problems of diverse scope and complexity ranging from moderate to substantial
- Experience in developing, maintaining, and collecting structured and unstructured data sets for analysis and reporting
- Experience in creating reports, projections, models, and presentations to support business
- Ability to exercise independent judgment and decision making on complex issues regarding job duties and related tasks
- Ability to works under minimal supervision, using independent judgment
- At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required
- Doctorate degree
- Experience with claims datasets
- Experience with Databricks
Benefits
- This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
- Medical benefits
- Dental benefits
- 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
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Remote work arrangement
Company Overview
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