Principal Data Scientist, Healthcare Analytics Lead

Blue Cross and Blue Shield of North Carolina; Utah; On-site; USD 144,000 - 230,000; Full time

Job summary

Blue Cross NC seeks a Principal Data Scientist to lead complex data science and engineering initiatives, translating data into strategic decisions and partnering with cross-functional teams for enterprise-wide impact.

You will own delivery of multiple large-scale projects, build scalable data pipelines, apply advanced analytics including ML, and present insights to executive leadership to influence outcomes.

Qualifications

• Bachelor's degree or advanced degree 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.

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

Big Data

Data Analysis

Data Engineering

Data Mining

Data Modeling

Data Science

Data Visualization

Machine Learning

Predictive Analytics

Predictive Modeling

Python

Statistical Analysis

Statistical Models

Snowflake

AI Agents

Bell Curve Analysis

Industry Benchmarks

Outlier Detection

Education

Bachelor's degree or advanced degree

Tools

Snowflake

AI Agents

Job description

Blue Cross NC seeks a Principal Data Scientist to lead complex data science and engineering initiatives, translating data into strategic decisions and partnering with cross-functional teams for enterprise-wide impact.

You will own delivery of multiple large-scale projects, build scalable data pipelines, apply advanced analytics including ML, and present insights to executive leadership to influence outcomes.