Data Modeler Lead - Healthcare Domain

Position Overview:

Data Modeler/Lead

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.