Role 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 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 : 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 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. (ref:hirist.tech) Show more Show less

We are seeking an experienced Data Catalog Lead to lead the implementation and ongoing development of enterprise data catalog using Collibra. This role focuses specifically on healthcare payer industry requirements, including complex regulatory compliance, member data privacy, and multi-system data integration challenges unique to health plan operations. Key Responsibilities Data Catalog Implementation & Development : Configure and customize Collibra workflows, data models, and governance processes to support health plan business requirements Develop automated data discovery and cataloging processes for healthcare data assets including claims, eligibility, provider networks, and member information Design and implement data lineage tracking across complex healthcare data ecosystems spanning core administration systems, data warehouses, and analytics Data Governance : Build specialized data catalog structures for healthcare data domains including medical coding systems (ICD-10, CPT, HCPCS), pharmacy data (NDC codes), and provider taxonomies Configure data classification and sensitivity tagging for PHI (Protected Health Information) and PII data elements in compliance with HIPAA requirements Implement data retention and privacy policies within Collibra that align with healthcare regulatory requirements and member consent management Develop metadata management processes for regulatory reporting datasets (HEDIS, Medicare Stars, MLR reporting, risk adjustment) Technical Integration & Automation Integrate Collibra with healthcare payer core systems including claims processing platforms, eligibility systems, provider directories, and clinical data repositories Implement automated data quality monitoring and profiling processes that populate the data catalog with technical and business metadata Configure Collibra's REST APIs to enable integration with existing data governance tools and business intelligence platforms Required Qualifications Collibra Platform Expertise : 8+ years of hands-on experience with Collibra Data Intelligence Cloud platform implementation and administration Expert knowledge of Collibra's data catalog, data lineage, and data governance capabilities Proficiency in Collibra workflow configuration, custom attribute development, and role-based access control setup Experience with Collibra Connect for automated metadata harvesting and system integration Strong understanding of Collibra's REST APIs and custom development capabilities Healthcare Payer Industry Knowledge 4+ years of experience working with healthcare payer/health plan data environments Deep understanding of healthcare data types including claims (professional, institutional, pharmacy), eligibility, provider data, and member demographics Knowledge of healthcare industry standards including HL7, X12 EDI transactions, and FHIR specifications Familiarity with healthcare regulatory requirements (HIPAA, ACA, Medicare Advantage, Medicaid managed care) Understanding of healthcare coding systems (ICD-10-CM/PCS, CPT, HCPCS, NDC, SNOMED CT) Technical Skills Strong SQL skills and experience with healthcare databases (claims databases, clinical data repositories, member systems) Knowledge of cloud platforms (AWS, Azure, GCP) and their integration with Collibra cloud services Understanding of data modeling principles and healthcare data warehouse design patterns Data Governance & Compliance Experience implementing data governance frameworks in regulated healthcare environments Knowledge of data privacy regulations (HIPAA, state privacy laws) and their implementation in data catalog tools Understanding of data classification, data quality management, and master data management principles Experience with audit trail requirements and compliance reporting in healthcare organizations Preferred Qualifications Advanced Healthcare Experience : Experience with specific health plan core systems (such as HealthEdge, Facets, QNXT, or similar platforms) Knowledge of Medicare Advantage, Medicaid managed care, or commercial health plan operations Understanding of value-based care arrangements and their data requirements Experience with clinical data integration and population health analytics Technical Certifications & Skills Collibra certification (Data Citizen, Data Steward, or Technical User) Experience with additional data catalog tools (Alation, Apache Atlas, IBM Watson Knowledge Catalog) Knowledge of data virtualization tools and their integration with data catalog platforms Experience with healthcare interoperability standards and API management (ref:hirist.tech)