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 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 the Individual & Family Plan (IFP) Line of Business under the Government Markets Organization.

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 IFP, Actuarial, HQA, Network Operations, 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, and Covered CA regulatory reporting, 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 bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree . Master's degree preferred
• Requires 7 years of relevant experience delivering healthcare analytics (cost, quality, utilization, and/or outcomes)
• Requires 5+ years advanced experience working with complex Medical Claims, Membership and Provider data architectures
• Requires advanced coding proficiency in SQL & Python, with strong applied experience in SAS 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 deep domain fluency with IFP lines of business (On Exchange, Off Exchange, Covered CA Small Business) and standard enrollment and claims data structures
• Requires high degree of fluency with PEGA, Salesforce and similar enterprise CRM/outreach applications
• Requires high degree of proficiency with interpersonal communication, verbal/written presentations, math, analytical problem-solving, and the ability to adapt quickly to shifting or competing priorities
  

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.