Healthcare Navigation Data Scientist -Virtual

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We're seeking a Data Scientist to help enhance provider search, recommendation, and value measurement capabilities across our Health Navigation platform. In this role, you'll leverage healthcare data, analytics, and predictive modeling to improve provider recommendations, uncover cost and utilization insights, and demonstrate measurable client value.

You will collaborate with Product, Engineering, Clinical, and Value Engineering teams to develop scalable, data-driven solutions that improve member outcomes, increase engagement, and support healthcare affordability.

** Please NOTE: Applicants must reside in the United States in one of the 50 States or the District of Columbia in order to be considered for this role. **

**US Citizenship requirements- as this role supports services provided to the federal government and/or a federal government contractor, proof will be required to verify US citizenship status at time of hire.**
Key Responsibilities

- Analyze healthcare and book-of-business data to identify cost drivers, utilization trends, and opportunities to improve member outcomes and reduce healthcare spend.

- Develop and enhance provider scoring, ranking, and recommendation methodologies using factors such as cost, quality, specialty alignment, and provider experience.

- Integrate and transform complex healthcare datasets, including claims, provider, pricing, and network data, to support analytics and modeling initiatives.

- Build, validate, and optimize statistical, predictive, and machine learning models that improve provider search relevance and personalization.

- Evaluate business rules, scoring outputs, and recommendation performance to ensure alignment with clinical and business objectives.

- Monitor key performance metrics, identify opportunities for continuous improvement, and recommend enhancements to data sources, models, and processes.

- Partner cross-functionally with Product, Engineering, Clinical, and Business teams to translate analytical insights into actionable solutions and measurable business value.

Requirements

- Experience working with large, complex datasets using SQL and Python and/or R .

- Experience developing data models, scoring frameworks, predictive analytics, or machine learning solutions.

- Knowledge of healthcare datasets and concepts, including claims data, CPT, ICD, NPI, provider networks, and healthcare pricing.

- Understanding of healthcare cost drivers, utilization analytics, quality measures