Data Modeler Lead - Healthcare Domain

Role : Data Modeler Lead
Location : Remote Experience : 10years+ Healthcare experience is Mandatory 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 candidate should 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 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 eAorts 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 organization