Data Scientist

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.
We are seeking a mission-driven Data Scientist to join our growing team and support risk adjustment strategy within our Medicare Advantage line of business. This role focuses on enhancing risk score accuracy, CMS audit preparedness (RADV), and building AI-powered tools that improve clinical documentation review and integrity.
You’ll play a key role in advancing AVA, our proprietary clinical intelligence platform, by developing next-generation models that support autonomous chart review and NLP/GenAI-driven documentation analytics. This is a unique opportunity to work at the intersection of healthcare, compliance, and machine learning—transforming how we ensure both quality and regulatory alignment.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.

We are seeking a mission-driven Data Scientist to join our growing team and help develop predictive models and intelligent workflows that drive better member health outcomes, improve quality metrics, and enhance operational efficiency across our Medicare Advantage offerings. You'll work on a diverse portfolio of high-impact projects spanning clinical intelligence, quality improvement, payment integrity, and emerging AI/NLP solutions, all underpinned by our proprietary AVA technology platform.

This is a unique opportunity to work at the intersection of healthcare, machine learning, and real-world impact, applying advanced analytics to solve complex problems that improve the quality of healthcare for our members.

Job Duties/Responsibilities

• Collaborate with business stakeholders to understand complex healthcare and operational challenges, then design and implement analytical solutions that drive measurable outcomes

• Develop predictive models and workflows for AVA, our proprietary clinical intelligence platform, supporting autonomous chart review, clinical analytics, disease detection, and compliance forecasting

• Build and deploy scalable model pipelines that integrate NLP, random forests, gradient boosted algorithms, ensemble models, and data processing using Python, R, Databricks, MLFlow, and Unity Catalog

• Design and implement quality improvement models in partnership with our Quality team to enhance member health outcomes, improve Stars ratings, and support HEDIS reporting and forecasting initiatives

• Develop automated validation and quality assurance models for the Payment Integrity team to improve accuracy and reduce manual review burden

• Build AI / NLP / LLM solutions for document understanding, including the training of vision detection algos and development / deployment of OCR and NER pipelines that process medical charts at scale

• Collaborate with engineering teams to version, test, and deploy models using Git, CI/CD pipelines, GitHub, Azure, and cloud-based infrastructure

• Design algorithms to predict audit risk and detect documentation anomalies across cohorts and markets, supporting RADV audit preparedness and CMS compliance

• Partner cross-functionally with Pharmacy, Actuaries, Clinical, Data Engineering, and Software Engineering teams to ensure analytical outputs align with CMS guidance and regulatory requirements

• Support CMS Star Ratings strategy, including HEDIS, CAHPS, and HOS analysis and predictive modeling, and root cause analysis on rate movement through the measurement year

• Help standardize definitions, documentation logic, and reporting workflows at scale for enterprise-wide AI readiness and analytical capabilities

Supervisory Responsibilities: N/A

MINIMUM REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

• 2+ years of relevant experience in predictive modeling, machine learning, and data science

• Demonstrated ability to build end-to-end data science solutions with measurable real-world impact

Education/Licensure:

• Preferred: MSc or PhD in Computer Science, Engineering, Mathematics, Statistics, or related field, OR equivalent professional experience

Other:

• Strong programming proficiency in Python and/or R (primary focus for this role)

• Solid understanding of data structures, algorithms, and software engineering principles

• Demonstrated proficiency in SQL and relational databases

• Experience with Git and version control workflows

• Deep knowledge of machine learning algorithms, including deep neural networks, NLP, and LLMs

• Experience manipulating and analyzing complex, high-volume, high-dimensionality, and unstructured data from multiple sources

• Expertise in experimental design, statistical rigor (confidence intervals, significance testing, train/test/validation methodology)

• Strong data visualization and presentation skills; ability to translate complex analysis into actionable insights

• Excellent communication and collaborative problem-solving abilities

• Demonstrated ability to thrive in ambiguous, fast-paced environments while prioritizing effectively

• Strong analytical mindset with attention to detail and commitment to data quality

Preferred Qualifications:

• Healthcare industry experience or familiarity with healthcare data challenges

• Hands-on experience with Databricks for distributed data processing and ML workflows

• Experience with MLFlow and Unity Catalog for model versioning and governance

• Experience with Azure, AWS, or other cloud ecosystems

• Familiarity with NoSQL databases

• Knowledge of CMS and Medicare Advantage operations

• Published work in academic conferences or industry circles

• Experience with containerized environments and CI/CD pipelines

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL PHYSICAL FUNCTIONS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $149,882.00 - $224,823.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].