Job Title: Data Modeler Lead with Healthcare domain Location: Remote Duration: 6 months Contract • • • • • Healthcare Payer exp is must • • • • • • • • Core Focus: Data warehousing modeling (OLAP only), not OLTP. • Domain Expertise: Strong exposure to the healthcare payer domain. • Technical Skills: o Data Platforms: Oracle (on-prem) & Databricks (cloud) o ETL Tools: Informatica IDMC o Data Engineering: Data pipelines experience • Mandates: o Deep experience with payer subdomains: membership, eligibility, claims (medical, pharmacy, vision), provider info, health plans o Strong data modeling experience across RDBMS (SQL Server also acceptable) Data Modeler / Lead - Healthcare Data Systems Position Overview We are seeking an experienced Data Modeler/Lead with deep expertise in health plan data models and enterprise data warehousing to drive our healthcare analytics and reporting initiatives. The candidate should have hands-on experience with modern data platforms and a strong understanding of healthcare industry data standards. Key Responsibilities Data Architecture & Modeling • Design and implement comprehensive data models for health plan operations, including member enrollment, claims processing, provider networks, and medical management • Develop logical and physical data models that support analytical and regulatory reporting requirements (HEDIS, Stars, MLR, risk adjustment) • Create and maintain data lineage documentation and data dictionaries for healthcare datasets • Establish data modeling standards and best practices across the organization Technical Leadership • Lead data warehousing initiatives using modern platforms like Databricks or traditional ETL tools like Informatica • Architect scalable data solutions that handle large volumes of healthcare transactional data • Collaborate with data engineers to optimize data pipelines and ensure data quality Healthcare Domain Expertise • Apply deep knowledge of health plan operations, medical coding (ICD-10, CPT, HCPCS), and healthcare data standards (HL7, FHIR, X12 EDI) • Design data models that support analytical, reporting and AI/ML needs • Ensure compliance with healthcare regulations including HIPAA/PHI, and state insurance regulations • Partner with business stakeholders to translate healthcare business requirements into technical data solutions Data Governance & Quality • Implement data governance frameworks specific to healthcare data privacy and security requirements • Establish data quality monitoring and validation processes for critical health plan metrics • Lead efforts to standardize healthcare data definitions across multiple systems and data sources Required Qualifications Technical Skills • 10+ years of experience in data modeling with at least 4 years focused on healthcare/health plan data • Expert-level proficiency in dimensional modeling, data vault methodology, or other enterprise data modeling approaches • Hands-on experience with Informatica PowerCenter/IICS or Databricks platform for large-scale data processing • Strong SQL skills and experience with Oracle Exadata and cloud data warehouses (Databricks) • Proficiency with data modeling tools (Hackolade, ERwin, or similar) Healthcare Industry Knowledge • Deep understanding of health plan data structures including claims, eligibility, provider data, and pharmacy data • Experience with healthcare data standards and medical coding systems • Knowledge of regulatory reporting requirements (HEDIS, Medicare Stars, MLR reporting, risk adjustment) • Familiarity with healthcare interoperability standards (HL7 FHIR, X12 EDI) Leadership & Communication • Proven track record of leading data modeling projects in complex healthcare environments • Strong analytical and problem-solving skills with ability to work with ambiguous requirements • Excellent communication skills with ability to explain technical concepts to business stakeholders • Experience mentoring team members and establishing technical standards Preferred Qualifications • Experience with Medicare Advantage, Medicaid, or Commercial health plan operations • Cloud platform certifications (AWS, Azure, or GCP) • Experience with real-time data streaming and modern data lake architectures • Knowledge of machine learning applications in healthcare analytics • Previous experience in a lead or architect role within healthcare organizations