Data Modeler Lead

Role : Data Modeler Lead

Location : Remote

Experience : 10years+

Healthcare experience is Mandatory

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 eAorts 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