Lead Data Scientist Our customers is a growing health benefits company. The company is hiring a Lead Data Scientist to own its predictive cost models that will forecast future healthcare spend for employer populations and turn that into pricing decisions leadership can act on. The ideal candidate has hands-on experience with claims data and has built pricing models within the healthcare space. This is part of a larger modernization for this candidate to deliver additional models and help build internal AI products.
Responsibilities
Lead development of predictive models that forecast next-year healthcare cost and utilization for employer groups
Build modeling approaches that hold up with incomplete or open claims data, where missing claims don't mean missing care
Develop and validate PMPM, trend, and high-cost claimant methodologies
Incorporate risk adjustment and scoring (HCC, ACG, DxCG, or similar) into pricing models
Translate model output into clear recommendations for underwriting, finance, and executive stakeholders
Set modeling standards, validation practices, and documentation for a small data team
Work with data engineering to define data requirements and close quality gaps
Requirements
8+ years in data science or predictive analytics, with recent hands-on work on medical and Rx claims
Proven experience building cost or utilization prediction models in group underwriting, stop-loss, payer, TPA, or health analytics consulting
Fluency in PMPM, member months, IBNR/claims lag, allowed vs. paid, and risk scoring
Strong Python or R, plus SQL, with the ability to explain models to non-technical leaders
Experience leading or mentoring other data scientists preferred
Numbers & Facts
Location
Philadelphia, PA (Remote)
Salary
$85–$95 Per Hour
Skills
Artificial Intelligence (AI)unmatched
Consultingunmatched
Cost Modelingunmatched
Data Scienceunmatched
Financeunmatched
Forecastingunmatched
Health Planunmatched
Healthcareunmatched
Leadershipunmatched
Mentoringunmatched
Model Validationunmatched
Predictive Modelingunmatched
Prescription Drugsunmatched
Pricingunmatched
Product Pricingunmatched
Python Programming/Scripting Languageunmatched
R Programming Languageunmatched
Requirements Managementunmatched
Riskunmatched
SQL (Structured Query Language)unmatched
Underwritingunmatched
Validation Documentationunmatched
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