Job Description

Job Title: Senior Data Scientist

Location: NYC

You are an experienced, mission-driven team member who can flex and adapt to the shifting circumstances of a growth-stage startup. The Senior Data Scientist role is responsible for supporting business, clinical care, and member engagement to enhance care quality , reduce costs , and improve health and financial outcomes using advanced analytics. You will have the opportunity pioneering the application of agentic AI to processes in the health care industry to make analytics more scalable.

Key Responsibilities

Operational Analytics

• Enrollment reconciliation: Develop and maintain processes to ensure accuracy between eligibility systems, insurers, and state exchanges
• Financial dashboard : Track premium payment and support monthly financial reconciliation with dashboards to monitor cash flow outlook.
• Claims oversight: Analyze claims to detect anomalies, improve processing efficiency, and support provider contracting strategies. Monitor claims payout with financial models, adjust parameters to better align with financial cycles and expectations.
• Provider directory management [AS1] : Support initiatives to assess and improve network adequacy. Build and optimize frameworks to ensure data integrity and accessibility.
• Marketing analytics: Drive data-informed decisions with market segmentation, campaign effectiveness analysis, customer behavior modeling, and ROI analysis. Measure the effectiveness of campaigns and ultimately enhance customer engagement.

Clinical Insights & Decision Support

• Next best action (NBA) : Design and refine NBA algorithms to support personalized care recommendations in telehealth settings.
• NCQA milestones : Track and fulfill NCQA requirements, ensuring compliance with quality benchmarks and continuous improvement in clinical outcomes.

Product Analytics

• Funnel engagement: Design and build user funnels to analyze features usage and optimize/track/optimize key user journeys.
• Behavior analytics : Analyze user behavior across different touchpoints to identify trends, drop-off points, and opportunities for improvement.
• Care navigation: Develop models to enhance care navigation, ensuring members receive timely, appropriate, and cost-effective care.
• Medication compliance : Monitor and improve through data-driven interventions, partnering with clinicians and pharmacy teams.

Qualifications & Skills

Required:

• Bachelor’s or Master’s degree in Computer Science, Statistics, Public Health, Healthcare Informatics, or a related field.
• Fluent with tools for dashboarding and data visualizations such as Big Query and Looker
• Experience with SQL and Python for data science, data analysis and visualization.
• Knowledge of healthcare data , including claims, eligibility, provider, and clinical data.
• Familiarity with machine learning models for risk stratification and behavioral predictions.

Preferred:

• Proficiency in working with health insurance operations , including enrollment, claims, and provider networks.
• Understanding of NCQA, HEDIS, and other healthcare quality metrics .
• Knowledge of healthcare compliance and data privacy regulations (HIPAA, CMS guidelines).
• Prior work in telehealth, digital health, or value-based care environments.
• Strong stakeholder communication and data storytelling skills to translate insights into business actions.

[AS1] Gozde?

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