Job Description
The Principal Data Scientist will serve as the principal lead to provide accurate and quality analyses that translate data in sound organizational decisions. In this role you will provide strategic thought leadership and partner with other functional areas to deliver collaborative work products that align with divisional and enterprise strategy. You will own delivery of multiple large and/or complex data science and engineering projects.What You'll Do
Lead in the development and testing of hypotheses across all functional data sets
Lead requirements gathering sessions with business and technical staff to distill technical requirement from business requests
Define and implement integrated data models, allowing integration of data from multiple sources
Design and develop scalable, efficient data pipeline processes to handle data ingestion, cleansing, transformation, integration, and validation
Define and implement data stores based on system requirements and consumer requirements
Design and develop models to understand and solve multiple complex business solutions using a variety of methods including data mining, statistical analysis, predictive modeling and analysis, stochastic modeling, pattern recognition, probability analysis, and network analysis
Design and implement production models leveraging technologies such Python, and R
Leverage existing data sets and engineer new data sets including development of SQL queries, data integration and resolution of data quality issues
Apply advanced conceptual understanding of Big Data systems to data set engineering and analytic model implementation
Lead development and reviews of complex analytic models and algorithms
Identify actionable insights, suggest recommendations, and influence business direction by effectively communicating results to cross functional groups
Document and test analytic processes including performance and thorough data validation and verification
- Engage with enterprise business areas to incorporate feedback into audit process including but not limited to Payment Integrity, SIU, Provider, Behavioral Health, Med Policy, Claims, Pharmacy
- Articulate analytic methods and drive business outcomes with responsible business areas
- Consult with executive level leadership across the organization – with responsibility to drive CoC ideation for Commercial and Medicare
- Informally lead other analysts and synthesize information and make recommendations to executive leadership
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field.
Strong Analytic/Data Science skills:
Experience with Snowflake
Experience building AI Agents
Understand Bell curve analysis
Incorporate Industry benchmarks into analysis
Perform outlier detection
Strong healthcare experience with Payment Integrity/FWA business knowledge is required
understanding of FWA concepts, CMS guidelines, Medical/Reimbursement Policy are all strongly preferred
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
Skills
Big Data, Complex Data Analysis, Data Analysis, Data Engineering, Data Mining, Data Modeling Techniques, Data Science, Data Visualization, Machine Learning (ML), Predictive Analytics, Predictive Modeling, Python (Programming Language), Statistical Analysis, Statistical Models_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].
Skills Required
- Bachelor's degree or advanced degree (or 10+ years experience in lieu of degree)
- 8+ years of experience in related field
- Strong analytic and data science skills (statistical analysis, predictive modeling, outlier detection)
- Experience with Snowflake
- Experience building AI Agents
- Proficiency with Python for production models
- Proficiency with R for production models
- Experience developing SQL queries and data integration
- Experience engineering large/Big Data systems and scalable data pipelines
- Strong healthcare experience with Payment Integrity/FWA business knowledge
- Understanding of Bell curve analysis and incorporation of industry benchmarks
- Understanding of FWA concepts, CMS guidelines, Medical/Reimbursement Policy
What We Do
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,500 North Carolinians and serve more than 3.7 million customers. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association.
