Healthcare Data Scientist – Claims, Quality, & Provider Performance

Vālenz Health is a platform aimed at simplifying healthcare by reducing costs and improving quality. The Healthcare Data Scientist will work with complex healthcare claims data to ensure accuracy and integrity, applying statistical methods to provide actionable insights for decision-making.

Responsibilities:

• Utilize reference data sources and advanced validation techniques to ensure accuracy, completeness, and integrity of healthcare claims data
• Assess provider scoring methodologies, identify discrepancies, and develop insights to optimize coverage accuracy
• Design, develop, and maintain retrospective models for historical performance analysis, and predictive models to identify high-risk patients and prioritize actionable interventions
• Translate complex analytical findings into clear, actionable insights, and effectively communicate results and recommendations to internal stakeholders and external clients
• Aggregate and reconcile multiple data sources, applying statistical and computational methods to verify data integrity, identify anomalies, and implement necessary corrections
• Execute comprehensive data analysis workflows, evaluate outcomes, and implement enhancements to improve model accuracy and data reliability
• Review and optimize claim-matching processes, troubleshoot inconsistencies, and resolve data discrepancies to maintain high-quality outputs
• Investigate data quality issues, conduct root cause analysis, document findings, and deliver actionable recommendations for process improvements
• Collaborate with cross-functional teams to enhance analytical tools, refine methodologies, and implement scalable solutions that improve efficiency and analytical capabilities

Requirements:

• Bachelor's degree in a quantitative field (e.g., Statistics, Mathematics, Engineering, Computer Science, Finance, or Economics)
• 7+ or more years of experience analyzing healthcare claims data, including complex and imperfect datasets
• Strong analytical, problem-solving, and critical-thinking skills with proven ability to uncover root causes
• Proficiency in SQL for querying and manipulating data; familiarity with Python or similar data tools preferred
• Advanced Excel skills, including PivotTables and complex formulas, for data modeling and reporting
• Knowledge of healthcare network rosters, provider data, and quality measurement methodologies
• Exceptional attention to detail with a commitment to accuracy, data validation, and quality assurance
• Highly organized and self-motivated, with the ability to manage multiple priorities independently while collaborating effectively with others
• Master's degree