Data Scientist IV - Risk Adjustment: Medicare, Medicaid, ACA

Data Scientist IVThe Risk Adjustment Strategic Analytics team is seeking a Data Scientist IV to play a strategic and technical role in advancing Government Programs- Risk Adjustment through the application of advanced data science techniques, including machine learning, predictive modeling, and statistical inference. This senior position is responsible for designing and implementing scalable, end-to-end data science solutions that enhance risk score accuracy, support regulatory compliance, and drive financial performance across Medicare Advantage, ACA, and Medicaid programs.Using Python and cloud-based analytics platforms, the Data Scientist develops and manages machine learning models to forecast risk, identify outreach opportunities, and evaluate program effectiveness. The role requires deep expertise in healthcare data (e.g., claims, encounter, enrollment), strong knowledge of HCC risk adjustment methodologies, and the ability to translate complex analytical outputs into actionable insights for both technical and executive audiences.As a thought leader, the Data Scientist collaborates across clinical, actuarial, and operational teams, mentors junior data scientists, and fosters a data-driven culture to support innovation and strategic decision-making across the organization.This individual contributor is primarily responsible for designing and developing data pipelines and automation for data acquisition and ingestion of raw data from multiple data sources and data formats by transforming, cleansing, and storing data for consumption. This role is also responsible for developing detailed problem statements outlining hypotheses and their effect on target clients/customers, analyzing and investigating complex data sets and summarizing key characteristics, selecting, manipulating and transforming data into features used in machine learning algorithms, training statistical models, deploying and maintaining reliable and efficient models through production, verifying model performance, and collaborating with internal and external stakeholders across domains to develop and deliver statistical driven outcomes.Essential responsibilities include promoting learning in others, completing work assignments autonomously, developing detailed problem statements, designing and developing data pipelines, analyzing and investigating complex data sets, selecting, manipulating, and transforming data into features, training statistical models, deploying and maintaining reliable and efficient models, verifying model performance, and collaborating with internal and external stakeholders.Minimum qualifications include three (3) years experience working with Exploratory Data Analysis (EDA) and visualization methods, three (3) years machine learning and/or algorithmic experience, three (3) years statistical analysis and modeling experience, three (3) years programming experience, one (1) year experience in a leadership role, a Bachelors degree in Mathematics, Statistics, Computer Science, Engineering, Economics, Public Health, or related field AND five (5) years experience in data science or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement. Advanced degrees may be substituted for the work experience requirements.Additional requirements include knowledge, skills, and abilities in advanced quantitative data modeling, algorithms, applied data analysis, data extraction, data visualization tools, machine learning, relational database management, Microsoft Excel, design thinking, business intelligence tools, data manipulation/wrangling, data ensemble techniques, feature analysis/engineering, open source languages & tools, model optimization, strategic thinking, deep learning/neural networks, and project management.Preferred qualifications include one (1) year experience working with Kubernetes and one (1) year experience working with Docker.Primary location: California, Oakland, Ordway. Additional locations include Pasadena, CA, Portland, OR, Honolulu, HI, Atlanta, GA, Rockville, MD, Aurora, CO, Washington, WA, Alexandria, VA, and Renton, WA.Scheduled weekly hours: 40 shift: Day. Workdays: Mon, Tue, Wed, Thu, Fri. Working hours start: 08:00 AM. Working hours end: 05:00 PM. Job schedule: Full-time. Job type: Standard. Employee status: Regular Worker. Location: Flexible. Employee group/union affiliation: NUE-PO-01|NUE|Non Union Employee. Department: MSSA Admin Offices - Medicare LOB Admin - 0308. Pay range: $166100 - $214940 / year.