Job
Description
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 candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards. About the Role The candidate will be responsible for leading data modeling initiatives and ensuring compliance with healthcare regulations while collaborating with various stakeholders to translate business requirements into technical solutions. Responsibilities: Data Architecture & Modeling Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management. Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment). Create and maintain data lineage documentation and data dictionaries for healthcare datasets. Establish data modeling standards and best practices across the organization. Technical Leadership Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica. Architect scalable data solutions that handle large volumes of healthcare transactional data. Collaborate with data engineers to optimize data pipelines and ensure data quality. Healthcare Domain Expertise Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI). Design data models that support analytical, reporting and AI/ML needs. Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations. Partner with business stakeholders to translate healthcare business requirements into technical data solutions. Data Governance & Quality Implement data governance frameworks specific to healthcare data privacy and security requirements. 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 experience in data modeling with at least 4 years focused on healthcare/health plan data. Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches. Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing. Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks). Proficiency with data modeling tools (Hackolade, ERwin, or similar). Healthcare Industry Knowledge Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data. Experience with healthcare data standards and medical coding systems. Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment). Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI). Leadership & Communication Proven track record of leading data modeling projects in complex healthcare environments. Strong analytical and problem-solving skills with ability to work with ambiguous requirements. Excellent communication skills with ability to explain 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. Previous experience in a lead or architect role within healthcare organizations. Show more Show less
