Capital Blue Cross is looking to fix fundamental problems in the healthcare industry by leveraging proprietary datasets and connections to claims, hospital system, and consumer data to create financial and societal benefit through healthcare data analytics and preventive medicine.
Requirements
- Deep intuition for and experience with predictive modeling (statistics and/or machine learning)
- Technical sophistication with relational and unstructured (big data) database concepts and applications, quantitative methods and related applications and decision support tools.
- Ability to analyze problems, issues, outcomes, determine/estimate/project impact and provide or recommend business solutions.
- SAS or R.
- Bonus experience: JavaScript, Python, Ruby, Perl, Linux, Hadoop, Matlab, SQL, knowledge of No SQL databases and big data philosophies.
- Experience in Machine Learning (strongly preferred), Predictive Modeling, Bayesian analysis, and causal inference methods
- Experience with quality studies, population based analysis, disease management, and background in research methodologies and statistics.
Responsibilities
- Responsible for the successful delivery of the design, development and implementation of machine learning and predictive models on the cost, utilization and quality trends relative to product, program, network, benefit design, employer group, etc. and the communication of this information to key internal and external stakeholders.
- Ensures that rigorous research design, comprehensive data collection and sound statistical methods are applied to the cost and utilization forecast, population management, internal and vendor programs, and corporate projects.
- Assessment and identification of cost and utilization reduction opportunities through collaboration with leadership and advisory boards.
- Provide guidance and support for project implementations within the appropriate Capital BlueCross area including processes to track cost, utilization and outcomes.
- Assists in developing an annual work plan for the department which considers available resources and anticipated workload.
Other
- Demonstrated strong oral, written and presentation skills.
- Bonus experience: Knowledge of managed care insurance and business processes, data, systems, and applications for claim payments, network and provider contract administration and management, population management.
- Experience mentoring junior and senior level team members on best analytic practices.
- Be effective at communicating complex structures.
- Have a high level of interpersonal skills.
