Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is a healthcare organization seeking a Principal Data Scientist to lead data-driven decision-making processes. The role involves providing strategic leadership, managing complex data science projects, and collaborating with various functional areas to align analyses with organizational goals.
Responsibilities
- Lead in the development and testing of hypotheses across all functional data sets
- Lead requirements gathering sessions with business and technical staff to distill technical requirement from business requests
- Define and implement integrated data models, allowing integration of data from multiple sources
- Design and develop scalable, efficient data pipeline processes to handle data ingestion, cleansing, transformation, integration, and validation
- Define and implement data stores based on system requirements and consumer requirements
- Design and develop models to understand and solve multiple complex business solutions using a variety of methods including data mining, statistical analysis, predictive modeling and analysis, stochastic modeling, pattern recognition, probability analysis, and network analysis
- Design and implement production models leveraging technologies such Python, and R
- Leverage existing data sets and engineer new data sets including development of SQL queries, data integration and resolution of data quality issues
- Apply advanced conceptual understanding of Big Data systems to data set engineering and analytic model implementation
- Lead development and reviews of complex analytic models and algorithms
- Identify actionable insights, suggest recommendations, and influence business direction by effectively communicating results to cross functional groups
- Document and test analytic processes including performance and thorough data validation and verification
- Engage with enterprise business areas to incorporate feedback into audit process including but not limited to Payment Integrity, SIU, Provider, Behavioral Health, Med Policy, Claims, Pharmacy
- Articulate analytic methods and drive business outcomes with responsible business areas
- Consult with executive level leadership across the organization – with responsibility to drive CoC ideation for Commercial and Medicare
- Informally lead other analysts and synthesize information and make recommendations to executive leadership
Skills
- Bachelor's degree or advanced degree (where required)
- 8+ years of experience in related field
- In lieu of degree, 10+ years of experience in related field
- Strong Analytic/Data Science skills
- Experience with Snowflake
- Experience building AI Agents
- Understand Bell curve analysis
- Incorporate Industry benchmarks into analysis
- Perform outlier detection
- Strong healthcare experience with Payment Integrity/FWA business knowledge is required
- Understanding of FWA concepts, CMS guidelines, Medical/Reimbursement Policy are all strongly preferred
Benefits
- 401(k) with employer match
- Paid Time Off (PTO)
- Competitive health benefits and wellness programs
Company Overview
Company H1B Sponsorship