Job Details

Job Title

The primary focus of this role is to develop and manage analytical tools that support improvements in Medicare Advantage Star Ratings. This includes CAHPS and HOS experience analytics, HEDIS dynamics, Pharmacy modeling, Operation metric movement to high reliability state all with a provider performance assessment and integration of CMS dynamic rule modifications. In addition, this position will be expected to understand the business goals (growth) and capital strength and make strategic recommendations to enhance business processes and reflect our strategic goals.

Responsibilities will include:

• Provides technical and quantitative analysis for predictive modeling group.
• Develops & maintains robust Stars analytical models, ensuring accuracy & adapting to evolving data and regulatory shifts.
• Assists in statistical data mining and actuarial research by applying advanced statistical concepts.
• Conducts A/B testing & implements interventions, maximizing effectiveness for Star Ratings and member outcomes.
• Develops methodologies to measure Stars initiatives impact, optimizing analytic tools for performance improvements.
• Participates in and is responsible for projects requiring advanced statistical analyses, innovative research, mathematical calculations, and technical skills.
• Conducts research utilizing predictive modeling.
• Interprets data and identifies correlations using both univariate and multivariate analysis.
• Presents findings and recommendations to appropriate groups.
• Prepares and delivers summary reports to the relevant or affected areas within the company.
• Helps to determine what actionable steps can be taken based on the findings.
• Communicates and trains users on model results.
• Develops custom, explainable models that enhance business processes to reflect corporate goals, experience, and current market conditions using pattern recognition, evolutionary computation, and machine learning algorithms.
• Document model requirements.
• Examine and analyze data to determine optimal modeling approach.
• Identify candidate risk factors.
• Build models using training, test, and cross-validation data sets.
• Share model results.
• Finalize model.
• Delivers conclusions.
• Deploy and maintain models with or without the assistance of the IT department.
• Oversees the creation, development, and maintenance of our models.
• Further involvement in communication of predictive model results to other departments.
• Involvement in the implementation of predictive model results into the appropriate system.
• Works with, mentors and provides direction (as necessary) to Predictive Modeler I.
• Participates in development of annual budget, goals, objectives, and systems.
• Additional communication to all affected departments. This includes the creation of appropriate documents (PowerPoint presentations, etc.) to be used in the communication of predictive model results to the company.
• Lead the deployment and maintenance of models with or without the assistance of the IT department.

Education: Bachelors degree in insurance, math, economics, statistics, or computer science required. Advanced degree in statistics, actuarial science, or applied mathematics preferred. Continuous learning, as defined by the Companys learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

Experience: 4-6 years of research and modeling in Healthcare industry experience required. Medicare Advantage experience is preferred.

Skills/Knowledge/Abilities (SKA) Required: Excellent interpersonal, organizational, and communication skills. Demonstrated ability in statistical modeling and data mining techniques (GLM, clustering, decision trees, etc). Expertise in statistical programming languages like Python, R, SAS and SQL. Strong database querying skills including Databricks, MS SQL server. Ability to provide directions to other department analysts. Ability to use independent judgment and initiative and to anticipate needs of executive and department, accomplishing tasks without direction. Ability to work effectively as a member of a team. Resourceful problem-solving skills and desire to succeed. Knowledge of insurance and underwriting techniques, agency and policyholder needs. Ability to establish workflows, manage multiple projects, meet necessary deadlines, and work without supervision. Exercise sufficient