Chief Manager - Data Science
Role & responsibilities
As a Chief Manager of Analytics, you will sit at the intersection of data science and healthcare strategy. Primary responsibility is to transform Underwriting and claims and clinical data into actionable insights that improve member health outcomes while optimizing the cost of care for our corporate accounts and individual customers.
Preferred candidate profile
Key Responsibilities
1. Disease Risk Management & Stratification
- Predictive Modelling: Lead the development of models to identify "rising risk" membersthose likely to develop chronic conditions or experience acute events
- Program Evaluation: Measure the clinical and financial ROI of disease management programs
- Intervention Optimization: Use data to determine which clinical interventions are most effective for specific micro-segments of the population.
2. Managed Care & Network Analytics
- Value-Based Care (VBC): Analyse provider performance to support the transition from fee-for-service to value-based reimbursement models.
- Utilization Management: Monitor trends in medical necessity, prior authorizations, and length of stay to identify patterns of over-utilization or under-utilization.
- Cost Benchmarking: Compare unit costs and quality metrics across different healthcare providers and geographies to optimize the provider network.
3. Account & Customer Strategy
- B2B Reporting: Design and present sophisticated "Health of the Population" reports for large corporate accounts, highlighting cost drivers and wellness opportunities.
- Benefit Design: Use claims and clinical data to recommend changes in plan design that incentivize high-value care.
- Customer Experience: Identify friction points in the member journey using behavioural data to improve engagement with managed care services.
Required Skills & Qualifications
Proficiency in SQL, Python and Visualisation tool like Power BI & Tableau
Understanding of ICD, Risk Adjustment Factors
Data Science, Public Health background
Experience 3-5 years