Principal Data Scientist

Principal Data Scientist

Aetna, a CVS Health company, is a leading health innovation organization focused on transforming healthcare delivery and improving outcomes. As part of the growing Medicare Stars organization, we are seeking a Principal Data Scientist to lead advanced analytics, forecasting, and scientific modeling efforts that drive enterprise-level Star Ratings performance.

This role is a senior individual contributor and thought leader responsible for defining and scaling the next generation of Stars forecasting, cutpoint analytics, and performance modeling. The individual will lead development of predictive models, statistical frameworks, and AI-enabled analytics solutions to inform strategic decision-making across Medicare Stars domains.

This position will own end-to-end analytic strategy—from data engineering and model design to executive insights and business impact—and will serve as a key partner to leadership across Product, Clinical, Quality, and Data organizations.

Position Summary

Strategic Leadership & Analytics

• Lead the design and execution of enterprise-level Medicare Stars forecasting models, including multi-year projections (e.g., 2027–2029 stars scenarios).
• Define scientific frameworks for Stars cutpoint derivation, incorporating CMS methodology, guardrails, and national distribution analysis.
• Partner with senior leadership to translate forecast insights into actionable business strategies and risk mitigation plans.
• Provide thought leadership in Stars performance analytics, influencing roadmap, prioritization, and investments.

• Advanced Modeling & Forecasting:
• Develop and maintain end-to-end forecasting models across domains: CAHPS, HEDIS, HOS, Patient Safety / Pharmacy measures.
• Build year-end projections based on historical trends, seasonality, and industry benchmarks.
• Perform sensitivity analysis and scenario modeling (Low/Mid/High models) to quantify risk and opportunity.
• Design predictive models leveraging statistical methods, machine learning, and time-series forecasting.

• Translate regulatory changes into model enhancements and impact assessments.
• Lead efforts to interpret and operationalize CMS technical guidance (e.g., disaster adjustments, guardrails, cutpoint methodology).
• Experience in building year-end forecasts using historical trends and industry benchmarks.

Data, Technology Leadership & Technical Skills

• Architect and implement scalable analytics solutions using:
• Snowflake (Snowpark, data pipelines, governance)
• Python / SQL-based modeling frameworks
• ML/AI and LLM-enabled analytics (including RAG architectures)
• Build integrated data ecosystems combining:
• Structured clinical and operational data
• Survey and experience data (CAHPS/HOS)
• External industry benchmarks
• Data Visualization: Ability to create compelling visualizations using tools like Tableau, Power BI, and Snowflake and any other BI tools
• Author Snowpark/Python/SQL transformations, Streams & Tasks, and job orchestration to enable near-real-time and batch analytical workloads.
• Strong expertise in: Time-series forecasting, Machine learning & predictive modeling and Statistical inference and simulation modeling
• Database Management: Knowledge of SQL and NoSQL databases for efficient data storage and retrieval.
• Enable self-service analytics and executive dashboards for real-time decision support.

• Provide technical leadership and mentorship to data scientists and analysts.
• Integrate Snowflake with LLMs (OpenAI or equivalent) for tasks such as summarization, question-answering, classification, and code-generation—using External Functions, Snowpark, and/or secure API patterns.
• Establish best practices for modeling, validation, documentation, and version control.
• Ensure compliance with data governance, privacy, and regulatory standards.

• Advanced proficiency in Snowflake, Python, SQL, and statistical modeling frameworks
• Experience with Snowflake, cloud data platforms, and large-scale analytics pipelines
• Familiarity with LLM-enabled analytics and retrieval-augmented generation (RAG)

• Strong quantitative and problem-solving abilities
• Ability to translate complex data into clear business insights
• Expertise in building and validating predictive models

Leadership & Communication

• Executive-level communication and storytelling skills
• Proven ability to influence senior stakeholders
• Strong cross-functional collaboration and leadership experience

Required Qualifications

• 10+ years in data science, analytics, or forecasting roles
• Significant experience in Medicare Stars or healthcare quality analytics preferred
• Experience leading large-scale forecasting or Stars performance programs
• Proven track record of delivering enterprise-scale analytics solutions and business impact

Preferred Qualifications

• Certifications: Professional certifications in data science, machine learning, or business analytics can be beneficial.
• Experience with CMS Stars regulatory interpretation and analytics
• Prior work in Medicare Advantage or healthcare quality organizations

Education

• A bachelor's degree in a related field such as Statistics, Mathematics, Data Science, Economics, Computer Science, or related field. Advanced degrees (Master's or Ph.D.) in these fields are highly desirable.

Why This Role

This is a highly visible leadership role where you will directly shape the organization's Stars performance strategy, influence executive decision-making, and drive measurable outcomes in quality and member experience.

Pay Range: $144,200.00 - $288,400.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.