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Vālenz Health® · 6 hours ago

Healthcare Data Scientist – Claims, Quality, & Provider Performance

United States

Full-time

Remote

Senior Level

7+ years exp

Vālenz Health is the platform to simplify healthcare, seeking a Healthcare Data Scientist to work hands-on with complex healthcare claims and provider datasets. The role involves ensuring data accuracy and integrity, investigating anomalies, and delivering actionable insights to support decision-making across the organization.

Insurance

No H1B

Responsibilities

Utilize reference data sources and advanced validation techniques to ensure accuracy, completeness, and integrity of healthcare claims data

Assess provider scoring methodologies, identify discrepancies, and develop insights to optimize coverage accuracy

Design, develop, and maintain retrospective models for historical performance analysis, and predictive models to identify high-risk patients and prioritize actionable interventions

Translate complex analytical findings into clear, actionable insights, and effectively communicate results and recommendations to internal stakeholders and external clients

Aggregate and reconcile multiple data sources, applying statistical and computational methods to verify data integrity, identify anomalies, and implement necessary corrections

Execute comprehensive data analysis workflows, evaluate outcomes, and implement enhancements to improve model accuracy and data reliability

Review and optimize claim-matching processes, troubleshoot inconsistencies, and resolve data discrepancies to maintain high-quality outputs

Investigate data quality issues, conduct root cause analysis, document findings, and deliver actionable recommendations for process improvements

Collaborate with cross-functional teams to enhance analytical tools, refine methodologies, and implement scalable solutions that improve efficiency and analytical capabilities

Qualification

Healthcare claims analysisSQLStatistical methodsPythonAdvanced ExcelData validationProblem-solvingCritical thinkingAttention to detailOrganizational skills

Required

Bachelor's degree in a quantitative field (e.g., Statistics, Mathematics, Engineering, Computer Science, Finance, or Economics)

7+ or more years of experience analyzing healthcare claims data, including complex and imperfect datasets

Strong analytical, problem-solving, and critical-thinking skills with proven ability to uncover root causes

Proficiency in SQL for querying and manipulating data; familiarity with Python or similar data tools preferred

Advanced Excel skills, including PivotTables and complex formulas, for data modeling and reporting

Knowledge of healthcare network rosters, provider data, and quality measurement methodologies

Exceptional attention to detail with a commitment to accuracy, data validation, and quality assurance

Highly organized and self-motivated, with the ability to manage multiple priorities independently while collaborating effectively with others

Preferred

Master's degree

Benefits

Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card

Spending account options: HSA, FSA, and DCFSA

401K with company match and immediate vesting

Flexible working environment

Generous Paid Time Off to include vacation, sick leave, and paid holidays

Employee Assistance Program that includes professional counseling, referrals, and additional services

Paid maternity and paternity leave

Pet insurance

Employee discounts on phone plans, car rentals and computers

Community giveback opportunities, including paid time off for philanthropic endeavors

Company

Vālenz Health®

Vālenz Health® is the platform to simplify healthcare – the destination for employers, payers, providers, and members to reduce costs, improve quality, and elevate the healthcare experience.

Founded in 2004

Radnor, PA, US

501-1000 employees