Medical Informatics Analyst, Consultant

Your Role

The AI & Analytics (AI&A) team sits within the enterprise Growth organization, specifically aligned to the Risk Adjustment vertical. While situated within the Risk adjustment, this is strictly an advanced Medical Informatics and data architecture role. The Consultant will serve as a critical semantic bridge and analytical lead supporting multiple Government Lines of Business (LOBs) within Senior Markets with a distinct focus on Special Needs Plans (SNPs).

Reporting to the Sr Manager of Medical Informatics, this role is responsible for acting as an AI & Analytics partner to key leaders and cross-functional stakeholders across Medicare, Med Supp, Actuarial, and Finance to achieve their Growth-related business objectives. The successful candidate will act as "two-in-a-box" collaborator to share LOB Membership Retention & Growth goals, translate complex business problems into structured analytical approaches, design smart analytical tools, and leverage internal data structures to uncover CoHC optimization and member acquisition opportunities.

Your Knowledge and Experience

• Requires a college degree or equivalent experience. Master's degree preferred
• Requires a minimum 7 years of prior relevant experience with 5+ years advanced experience working with complex Medical Claims, Membership and Provider data architectures.
• Requires a minimum of 5 years' experience in Health Care (managed care, academic, or gov't payer),
• Requires a SAS Certified Base Programmer Credential or equivalent
• Requires advanced coding proficiency in SQL & SAS, with strong applied experience in Python and a working knowledge of modern cloud-native data stacks (Snowflake, Databricks, RDBMS etc.) for pipeline automation.
• Requires familiarity with AI coding assistants (e.g. GitHub Copilot, Codex) or a strong, demonstrated willingness to quickly learn and adopt AI tooling to optimize engineering efficiency
• Requires fluency with Senior Markets lines of business (MAPD, DSNP, Medicare Supplement, Medi-Cal) and CMS MARx regulatory data structures (MMR, DTRR, BEQ, etc.)
• Requires high degree of fluency with PEGA, Salesforce and similar enterprise CRM/outreach applications

• Requires proficiency in interpersonal communication, verbal/written presentations, math, analytical problem-solving, and the ability to adapt quickly to shifting or competing priorities