Job Description

Your Role

The AI & Analytics (AI&A) team sits within the enterprise Growth organization, specifically aligned to the Risk Adjustment vertical. While situated within the Risk adjustment, this is strictly an advanced Medical Informatics and data architecture role. The Consultant will serve as a critical semantic bridge and analytical lead supporting multiple Government Lines of Business (LOBs) within Senior Markets with a distinct focus on Special Needs Plans (SNPs).

Reporting to the Sr Manager of Medical Informatics, this role is responsible for acting as an AI & Analytics partner to key leaders and cross-functional stakeholders across Medicare, Med Supp, Actuarial, and Finance to achieve their Growth-related business objectives. The successful candidate will act as "two-in-a-box" collaborator to share LOB Membership Retention & Growth goals, translate complex business problems into structured analytical approaches, design smart analytical tools, and leverage internal data structures

Your Work

In this role, you will:

• Use deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
• Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies
• Lead the architectural transition of legacy, on-premise analytic workflows and data pipelines into modern, cloud-native environments, utilizing Databricks, Snowflake, and other enterprise-governed cloud tools to ensure scalable, automated business logic.
• Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts
• Communicate project status, progress, and outcomes to executive management
• Fulfill a leadership role in the critical review and ongoing development of data management and analytical systems for strategically important enterprise-wide analysis and reporting

• Serve as a technical mentor by reviewing SQL, SAS, and Python code of junior staff while working independently to drive complex portfolios forward with limited supervision. Integrate AI-assisted development tools (such as GitHub Copilot) into daily coding workflows to accelerate deployment timelines, enhance code quality, and support automated pre-peer-review safety nets. Be adept at creating new reusable assets

• Lead complex medical claims analysis to support Cost of Health Care (CoHC) analytics, dissecting trends, cost drivers, and billing methodologies to identify optimization and recover opportunities

• Improve member retention & conversion rates by collaborating with business partners to design and report from outreach tracking systems (e.g., PEGA, Salesforce) and conduct plan cost/value studies.

• Improve Acquisition by leveraging data from Markets, Provider, Geo, and Operations tracking to target and execute strategies that drive multi-product growth as customers transition through different life stages

• Ability to identify drivers of membership both internally and externally, as well as conversions from one product to another as customers transition through different life stages

Your Knowledge and Experience

• Requires a college degree or equivalent experience. Master’s degree preferred
• Requires a minimum 7 years of prior relevant experience with 5+ years advanced experience working with complex Medical Claims, Membership and Provider data architectures.
• Requires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer),
• Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
• Requires advanced coding proficiency in SQL & SAS, with strong applied experience in Python and a working knowledge of modern cloud-native data stacks (Snowflake, Databricks, RDBMS etc.) for pipeline automation.
• Requires familiarity with AI coding assistants (e.g. GitHub Copilot, Codex) or a strong, demonstrated willingness to quickly learn and adopt AI tooling to optimize engineering efficiency
• Requires fluency with Senior Markets lines of business (MAPD, DSNP, Medicare Supplement, Medi-Cal) and CMS MARx regulatory data structures (MMR, DTRR, BEQ, etc.)
• Requires high degree of fluency with PEGA, Salesforce and similar enterprise CRM/outreach applications

• Requires proficiency in interpersonal communication, verbal/written presentations, math, analytical problem-solving, and the ability to adapt quickly to shifting or competing priorities