Lead Data Scientist

Humana is seeking a Lead Data Scientist to drive advanced analytics that turn complex, high-volume data into actionable insights. This remote role is based in Puerto Rico and supports executive decision-making and strategy, with a strong focus on policy adherence measurement and scalable analytics implementation.

The Lead Data Scientist will apply mathematics, statistics, modeling, business analysis, and technology to develop analytic datasets, build reporting and projection outputs, and deliver models and presentations that guide functional strategies. The position also requires partnering across national teams to operationalize analytics related to compliance, including MHPAEA and other HUM policies.

Key Responsibilities

• Develop, maintain, and collect structured and unstructured data sets for analysis and reporting.
• Create reports, projections, models, and presentations to support business strategy and tactics.
• Advise executives on functional strategies, often at a segment-specific level.
• Act as a thought partner to shape innovative analytics solutions that produce actionable insights for policy adherence, improving compliance, operational consistency, and decision-making.
• Research, design, and implement a policy adherence metric using FRAC and PA denials information through advanced data modeling techniques.
• Design valuation model(s) to measure savings associated with removing outliers that are non-compliant with the policy adherence metric.
• Partner with National BH/Contracting/Medicaid/ND&PPS teams to support operational use of the metric, including compliance with MHPAEA and other HUM policies.
• Contribute to future measurement approaches for ancillary/inpatient psychiatric provider types and other opportunity areas.
• Manage stakeholders and expectations across teams, including data source owners, compliance, policy/governance, business, and PTC/National program partners.
• Influence priorities, tradeoffs, and roadmap decisions to drive implementation of a scalable solution.

Required Qualifications

• Master's Degree.
• Minimum 8 years of professional experience in data and analytics, transforming data sets into actionable insights and reporting.
• Minimum 5 years using SQL.
• Minimum 4 years of project leadership experience.
• Experience using mathematics, statistics, modeling/Machine Learning modeling, business analysis, and technology to transform high volumes of complex data into advanced analytic solutions.
• Demonstrated experience working on problems across a range of scope and complexity, from moderate to substantial.
• Experience developing, maintaining, and collecting structured and unstructured data sets for analysis and reporting.
• Experience creating reports, projections, models, and presentations to support business.
• Ability to exercise independent judgment and decision-making on complex issues related to job duties and tasks.
• Ability to work under minimal supervision using independent judgment.

Technologies

• SQL
• Databricks
• HireVue
• FRAC
• PA denials
• MHPAEA

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance

Work-At-Home Requirements

• At minimum, download speed of 25 mbps and upload speed of 10 mbps is recommended; wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Preferred Qualifications

• Doctorate degree
• Experience with claims datasets
• Experience with Databricks

Additional Information

• During the hiring process, Humana may contact you via text message and email to gather more information using the HireVue platform.
• HireVue Text, Scheduling and Video technologies allow interaction at the time and location most convenient for you.
• If selected to move forward from application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview.
• Your recorded interview will be reviewed, and you will be informed if you will be moving forward to the next round of interviews.

Schedule, Location, and Pay

• Location: Puerto Rico (remote)
• Scheduled weekly hours: 40
• Pay range: USD 156,500 - 215,300 per year
• This job is eligible for a bonus incentive plan.

Travel

• While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.