Data Scientist - Health Plan Operations

About This RoleAs a Risk Adjustment Data Scientist at myPlace Health, you’ll do more than work with numbers—you’ll help shape how we care for the communities we serve. In this role, you’ll partner closely with business, clinical, and operational leaders to uncover high-value challenges and design innovative, data-driven solutions. You’ll build predictive models, develop scalable data pipelines, and transform complex healthcare data into clear insights that guide critical decisions.
Your work will directly influence provider engagement, improve documentation and coding accuracy, and ensure compliant, data-driven risk adjustment submissions. By creating dashboards and tools that make data accessible and actionable, you’ll empower teams across the organization to deliver better outcomes for the participants who rely on us every day.

What Does Success Look Like In This Role?

• Shape High-Impact Solutions: Partner closely with our business and clinical leaders to uncover the most valuable challenges in risk adjustment and craft innovative, data-driven solutions that make a real difference in participant care.
• Bring Data to Life: Design and deploy predictive models that estimate risk scores and highlight anomalies across patient populations—empowering smarter, more proactive care.
• Build Strong Data Foundations: Contribute to robust data pipelines and scalable model infrastructure in Microsoft Fabric—integrating both structured and unstructured data to support our growing organization.
• Collaborate to Deliver: Work hand-in-hand with Product and Operations teams to create production-ready models using version-controlled workflows, CI/CD practices, and cloud environments that ensure reliability and agility.
• Illuminate the Journey: Track and analyze the full lifecycle of risk-adjustment submissions—including encounter data, EDPS, and RAPS—leveraging knowledge of CMS documents (MAO-004, MOR, MMR) to ensure accuracy and compliance.
• Turn Data Into Stories: Build intuitive dashboards in Power BI that transform complex data into clear, actionable insights for leaders and decision-makers across the organization.
• Drive Better Engagement: Monitor physician performance in risk-adjustment workflows, surfacing trends in documentation practices and coding accuracy while identifying opportunities for education and workflow optimization.
• Standardize for Scale: Develop consistent documentation logic, definitions, and reporting workflows that enable enterprise-wide analytics and improve operational efficiency.
• Simplify the Complex: Translate intricate data findings into meaningful, actionable insights that Operations, Clinical, and Finance teams can easily understand and apply.
• Pitch In Where Needed: Contribute to additional projects and priorities as they arise—bringing a collaborative mindset and problem-solving approach to new challenges.

What Does An Ideal Candidate Look Like?

• A Strong Educational Foundation: Master’s degree in Computer Science, Statistics, Mathematics, Engineering, or a related field.
• Proven Real-World Impact: 4+ years of experience applying machine learning and predictive modeling to solve meaningful problems.
• Hands-On Coding Expertise: Proficiency in Python (preferred) or R, with the ability to design and deliver end-to-end data science solutions.
• Data Wrangler Skills: Strong experience using SQL to query and transform large-scale healthcare data into insights that matter.
• Technical Rigor: Solid understanding of data structures, algorithms, and software engineering best practices.
• Advanced Machine Learning Know-How: Deep knowledge of techniques including predictive modeling, classification, and natural language processing.
• Healthcare Data Savvy: Experience analyzing large, complex datasets such as claims, EMR, enrollment, and operational data.
• Insight Translator: Proven ability to turn complex analysis into clear, actionable insights for both technical and non-technical stakeholders.
• Effective Communicator: Excellent written and verbal communication skills with a collaborative, problem-solving mindset.
• Risk Adjustment Expertise: Hands-on experience with healthcare risk adjustment models like CMS-HCC, PACE, or Medicare Advantage.
• Healthcare Data Familiarity: Knowledge of critical datasets including 837 files, EMR, and eligibility data.
• Workflow Awareness: Understanding of physician engagement processes that support coding accuracy and documentation excellence.
• Big Data Proficiency: Experience with technologies such as Spark, Fabric, Databricks, or Snowflake.
• Cloud Environment Experience: Comfortable working in platforms like Azure, AWS, or similar ecosystems.
• Visual Storytelling Skills: Skilled in using tools like Power BI, Tableau, or similar to present insights with clarity and impact.
• Startup-Ready Spirit: Adaptable, curious, and energized by the opportunity to thrive in a fast-growing, dynamic environment.

The Fine Print

• Hybrid with Purpose: Based in Los Angeles, supporting both our Greater Los Angeles and South Los Angeles centers, with up to 2 days per week onsite depending on business needs.
• Work-Life Balance You’ll Appreciate: Monday through Friday schedule designed to support a healthy balance between your professional and personal life.
• Collaborative Leadership: Reports directly to the Senior Director of Data Analytics, ensuring you have guidance and partnership from an experienced leader.

Physical Requirements

• Work comfortably in a primarily desk-based role with minimal physical demands.
• Lift or move only light office items occasionally (typically up to 10 pounds).
• Confidently and independently use computers, phones, and other standard office tools to get work done efficiently.
• Communicate on your own through phone calls, video meetings, email, and text—staying connected and collaborative wherever you are.
• Perform all essential job functions independently in both virtual and onsite settings, contributing seamlessly to the team.

Join Us and Make an ImpactAt myPlace Health, you’ll do more than work with data—you’ll turn insights into action that improves lives every day. If you’re excited to apply your expertise in a collaborative, mission-driven environment where innovation meets purpose, we’d love to hear from you. Bring your curiosity, your skills, and your passion for problem-solving, and help us shape the future of care for the seniors who need it most.