Position Overview:

We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The ideal candidate will have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards.

Key Responsibilities

Data Architecture & Modeling

Design and implement comprehensive data models supporting health plan operations, including member enrollment, claims processing, provider networks, and medical management.
Develop logical and physical data models that meet analytical and regulatory reporting requirements such as HEDIS, Stars, MLR, and risk adjustment.
Create and maintain data lineage documentation and data dictionaries for healthcare datasets.
Establish and enforce data modeling standards and best practices across the organization.

Technical Leadership

Lead data warehousing initiatives using platforms such as Databricks or ETL tools like Informatica.
Architect scalable data solutions capable of handling large volumes of healthcare transactional data.
Collaborate closely with data engineers to optimize data pipelines and ensure data quality.

Healthcare Domain Expertise

Apply extensive knowledge of health plan operations, medical coding systems (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI).
Design data models that support analytics, reporting, and AI/ML applications.
Ensure compliance with healthcare regulations including HIPAA and state insurance requirements.
Partner with business stakeholders to translate healthcare requirements into technical solutions.

Data Governance & Quality

Implement healthcare-specific data governance frameworks to ensure privacy and security of data.
Establish data quality monitoring and validation processes for critical health plan metrics.
Lead efforts to standardize healthcare data definitions across multiple systems and data sources.

Required Qualifications

Technical Skills

10+ years of data modeling experience, with at least 4 years focused on healthcare/health plan data.
Expertise in dimensional modeling, data vault methodology, or similar enterprise data modeling techniques.
Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing.
Strong SQL proficiency and experience with Oracle Exadata and cloud data warehouses (e.g., Databricks).
Proficient with data modeling tools such as Hackolade, ERwin, or equivalents.

Healthcare Industry Knowledge

Deep understanding of health plan data structures: claims, eligibility, provider, and pharmacy data.
Experience with healthcare data standards and medical coding systems.
Familiarity with regulatory reporting requirements (HEDIS, Medicare Stars, MLR, risk adjustment).
Knowledge of healthcare interoperability standards (HL7 FHIR, X12 EDI).

Leadership & Communication

Proven track record leading data modeling projects in complex healthcare environments.
Strong analytical and problem-solving skills with the ability to handle ambiguous requirements.
Excellent communication skills to effectively convey technical concepts to business stakeholders.
Experience mentoring team members and establishing technical standards.

Preferred Qualifications

Experience with Medicare Advantage, Medicaid, or Commercial health plan operations.
Cloud platform certifications (AWS, Azure, or GCP).
Experience with real-time data streaming and modern data lake architectures.
Knowledge of machine learning applications in healthcare analytics.
Prior experience in a lead or architect role within a healthcare organization.

Quality Analyst -Medical Coding

Data Modeler Lead - Healthcare Domain

Counselor