Claims RWE Engineer for Pharma

About CareSet CareSet transforms healthcare insights by decoding Medicare claims data, specializing in complex Medicare A, B, and D claims analysis. We leverage $1+ trillion in annual claims and 15+ years of continuously updated Medicare data to reveal insights hidden to most. The Role We need a client-facing engineer who can extract deep insights from healthcare claims data while consulting directly with pharmaceutical clients on their RWE strategies. This role combines technical excellence with consultative expertise. Core Focus Areas: • Physician Profile Analytics: Extracting HCP metadata, prescribing patterns, and treatment preferences from claims • Organizational Intelligence: Mapping referral networks, institutional affiliations, and organizational treatment protocols • Patient Journey Mapping: Building epidemiological models to construct patient pathways from diagnosis through treatment sequences Core RequirementsTechnical Expertise • Claims Data Experience Required: Hands-on experience with Medicare, Medicare Advantage, IQVIA, Symphony, Komodo, IBM, or other commercial claims datasets • Python Proficiency: Advanced Python skills for claims data processing, with SAS knowledge as a plus • Software Engineering Excellence: • Build scalable, reusable frameworks for claims analytics • Active GitHub contributor with strong version control practices • Develop and maintain shared code repositories • Create modular, well-documented code for team leverage • Experience with CI/CD pipelines and code review processes Domain Expertise • Patient Journey Modeling: Proven experience creating: • Time series patient exposure tables • Treatment sequence analytics • Line of therapy (LOT) identification • Combination therapy patterns • Regimen classification algorithms • Physician Segmentation & Targeting: Demonstrated ability to: • Extract referral patterns from claims • Build physician influence networks • Identify key opinion leaders through claims patterns • Map organizational affiliations and hierarchies • Epidemiological Modeling: Experience constructing: • Disease progression models from claims • Patient cohort definitions • Treatment pathway analytics • Outcomes tracking through claims continuity Client-Facing Skills • Consultative Expertise: Direct experience presenting complex analytics to pharmaceutical clients • Technical Translation: Ability to explain sophisticated methodologies to non-technical stakeholders • Project Leadership: Manage client expectations while delivering technical solutions • Strategic Thinking: Understand client business objectives and translate into analytical approaches Required Background • Pharma Analytics Experience: Current or recent role within pharmaceutical companies or serving pharma clients • RWE/HEOR Project Delivery: Proven track record delivering claims-based analytics for pharmaceutical decision-making • Client Engagement: Experience as a technical lead in client-facing consulting or analytics roles Key Responsibilities • Design and implement Python-based pipelines for processing healthcare claims data • Build reusable frameworks and contribute to shared code repositories via GitHub • Lead client meetings to understand requirements and present analytical findings • Extract physician metadata and organizational profiles from claims to support commercial analytics • Develop patient journey models focusing on oncology, hematology, and specialty therapeutic areas • Create referral network analytics and physician influence mapping • Translate complex claims patterns into actionable client insights • Mentor team members on code reusability and framework development Qualifications • Master's degree (PhD preferred) in epidemiology, biostatistics, health informatics, or related quantitative field • 7+ years working directly with healthcare claims data (Medicare, Medicare Advantage, or commercial) • 5+ years in pharma analytics or RWE consulting roles • Strong software engineering practices with demonstrable GitHub portfolio • Expert knowledge of ICD, CPT, HCPCS coding systems • Excellent presentation and communication skills What Sets You Apart • VRDC, Qualified Entity, or other research data center experience • Published research using claims data • Experience with Medicare Part D event files for drug exposure analytics • Track record of building production-ready, scalable analytics frameworks • Deep understanding of oncology treatment pathways and line of therapy algorithms • History of improving team efficiency through reusable code development • Ability to juggle multiple client projects while maintaining code quality Location: Remote Focus Areas: Oncology, Hematology, Ophthalmology, Specialty Therapeutics We're looking for a consulting engineer who can build scalable claims analytics solutions while working directly with our pharmaceutical clients. If you combine deep technical skills with the ability to translate complex analyses into business insights, and you're passionate about building reusable frameworks that elevate the entire team's capabilities, we want to talk to you.