Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com.
JOB SUMMARY:
We are seeking a Healthcare Data Scientist to support data-driven decision-making across a health insurance organization. This role focuses on leveraging claims, eligibility, risk adjustment, and quality data to improve member outcomes, manage medical costs, and support value-based care initiatives. The ideal candidate will partner with clinical, actuarial, care management, and business teams to deliver actionable insights and predictive models.
KEY RESPONSIBILITIES:
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Analyze and model medical, pharmacy, and behavioral health claims data.
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Develop predictive models for risk stratification, utilization management, readmissions, cost of care, and fraud/waste/abuse.
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Support population health, care management, and quality improvement programs.
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Collaborate with clinical, actuarial, and operational teams to translate business needs into analytics solutions.
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Create and maintain datasets using SQL, Python, and payer data models.
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Monitor model performance, bias, and data drift.
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Present insights to leadership using clear visualizations and storytelling.
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Ensure compliance with HIPAA, CMS, and internal data governance standards.
JOB REQUIREMENTS:
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3+ years of data science or advanced analytics experience in health insurance, managed care, or healthcare.
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Strong proficiency in Python and SQL.
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Hands-on experience with claims and eligibility data.
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Understanding of healthcare economics and utilization patterns
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Ability to communicate complex findings to non-technical business partners.
PREFERRED QUALIFICATIONS:
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Experience with risk adjustment (HCC), HEDIS, CMS Star Ratings.
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Knowledge of value-based care and care management analytics.
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Familiarity with cloud data platforms (AWS, Azure, GCP).
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Experience working with large-scale payer data warehouses.
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Exposure to fraud, waste, and abuse (FWA) analytics.
EDUCATION/CERTIFICATIONS:
- Bachelor’s or Master’s degree in Data Science, Statistics, Computer Science, Health Informatics, or related field
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/