Provide vision, strategy and operational leadership for the company’s health economics functions relating to business development, financial outcomes and contracting analysis.
Serve as primary corporate analytical contact for the company to support the information needs to support strategic and operational goals and objectives. Support to all lines of business
(Medicare/Medicaid/Exchanges/ASO/Hybrid), corporate departments, specialty companies, and state agencies in reviewing all costs Manage inpatient estimation process for all health plans to price out all stays for use in the month-end close process.
Manage revenue reconciliation process including verifying correct payments from the state, correct eligibility setup in the system, and correct claims payments Provide internal consulting for financial, IT, RFPs, rate setting and operational processes
Monitor and correct data quality and data processes throughout the organization Provide utilization and cost analyses to support health plan and corporate health benefits ratio, utilizing enterprise analytic and predictive models and data analysis tools.
Create an analytical environment that enhances medical cost decisions to maximize utilization of these tools. Support the business process and systems to ensure integrity of the health economics/data warehouse data.
Direct the consolidation of health information to support medical expenditure and utilization analyses and evaluate new tools/models to support business Identify risks and opportunities associated with future profitability and member retention
Support merger and acquisition opportunities with financial and statistical analysis
Conduct medical cost data economic analysis, research and development projects for the Health Plan’s and Finance to identify strategic and operational opportunities, using enterprise tools
The Senior Director of Data Science will lead the Data Science area within Data Science & Analytics. This team is dedicated to building data-driven solutions that have a measurable impact across all parts of the organization by aiding strategic product and content. The role will require a deep understanding of machine learning, deep learning, and AI techniques and their application in creating operational analytic solutions in member and provider analytics.
The position requires someone who is comfortable striking a balance between cutting-edge and pragmatic solutions.
Partnering with business stakeholders, product engineers, IT professionals and other groups within Enterprise Analytics they will ensure that analytic solutions can be leveraged throughout the organization to drive Centene business strategies.
Lead a team of talented data scientists in the design and development of foundational and operational analytic solutions that empower the organization to make key strategic decisions across the organization Be a thought leader in the application of cutting-edge techniques to real-world business problems
Foster a shared purpose among team members that enhances the capabilities of the team by building a collaborative learning environment
Education/Experience & Minimum Qualifications:
Bachelor’s degree in Finance, Economics, Statistics, Health Administration or related field.
8+ years of healthcare reporting and analytics. Leadership experience and skills required.
Knowledge of data systems, IT processes, and reporting tools including SQL, Teradata, Microstrategy required.
Experience with accounting practices, state reporting requirements, and rate setting activities preferred.
Preferred Qualifications/Skills: MS or PhD in quantitative field of study (mathematics, physical or biological sciences, data science etc.) from an accredited institution Inquisitive, conceptual thinker comfortable working on complex problems at the cutting edge with the limited definition of scope or guarantee of expected outcome
Deep experience in the application of machine learning, deep learning and analytic techniques in a media or entertainment company within a big-data environment.
Strong background in analytic programming (R, SparkR, Python, SAS) and data manipulation (SQL) in a big-data environment
Proven technical abilities, but must be capable of communicating complex analyses effectively to varying internal and external stakeholders, of varying seniority
Capability to lead multiple data science work streams simultaneously in a fast-paced environment in partnership with multiple business stakeholders
Demonstrated success executing and managing complex data science initiatives
Demonstrable experience leading a data science team in a healthcare, or big-data driven consumer-product company
Drive value in the broader business.
Develops and communicates goals, strategies, tactics, project plans, timelines, and key performance metrics to align with multiple internal stakeholder departments and ultimately grow companies analytics capabilities.
Applies a broad business approach to find and create value for the company.
Advanced level proficiency with statistical, machine learning modeling techniques such as regression, decision trees, neural networks, support vector machines, supervised/unsupervised clustering techniques, experimental test design, etc.
Expert theoretical knowledge of machine learning modeling techniques and advanced applied skills in developing predictive targeting models within distributed computing platforms such as Hadoop, AWS, Azure, GCP using tools like Spark, Scala, SAS, R, Python, Bayesian, H2O, Storm, Yarn, Kafka, Superior analytical skills.
Ability to perform insightful and actionable quantitative and qualitative analysis of the business.
Strong interpersonal skills-an outstanding ability to build relationships, influence and navigate within a complex organization.
Prepare and distribute medical cost lags and month-end close reporting to finance, utilizing enterprise tools
Licenses/Certifications: MBA, CPA preferred Employee
Job Level: Director/Sr. Director Job Type: Regular