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.
