Data Modeler Lead - Healthcare Domain

Position Overview :

We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards.

Key Responsibilities :

Data Architecture & Modeling :

- Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management

- Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment)

- Create and maintain data lineage documentation and data dictionaries for healthcare datasets

- Establish data modeling standards and best practices across the organization

Technical Leadership :

- Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica

- Architect scalable data solutions that handle large volumes of healthcare transactional data

- Collaborate with data engineers to optimize data pipelines and ensure data quality

Healthcare Domain Expertise :

- Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI)

- Design data models that support analytical, reporting and AI/ML needs

- Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations

- Partner with business stakeholders to translate healthcare business requirements into technical data solutions

Data Governance & Quality :

- Implement data governance frameworks specific to healthcare data privacy and security requirements

- Establish data quality monitoring and validation processes for critical health plan metrics

- Lead eAorts to standardize healthcare data definitions across multiple systems and data sources

Required Qualifications :

Technical Skills :

- 10+ years of experience in data modeling with at least 4 years focused on healthcare/health plan data

- Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches

- Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing

- Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks)

- Proficiency with data modeling tools (Hackolade, ERwin, or similar)

Healthcare Industry Knowledge :

- Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data

- Experience with healthcare data standards and medical coding systems

- Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment)

- Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI)

Leadership & Communication :

- Proven track record of leading data modeling projects in complex healthcare environments

- Strong analytical and problem-solving skills with ability to work with ambiguous requirements

- Excellent communication skills with ability to explain technical concepts to business stakeholders

- Experience mentoring team members and establishing technical standards

Preferred Qualifications :

- Experience with Medicare Advantage, Medicaid, or Commercial health plan operations

- Cloud platform certifications (AWS, Azure, or GCP)

- Experience with real-time data streaming and modern data lake architectures

- Knowledge of machine learning applications in healthcare analytics

- Previous experience in a lead or architect role within healthcare organization