Company :Highmark Health
Job Description :
This job builds audit analytical solutions using Artificial Intelligence regarding the evaluation of business processes and operations. The incumbent designs, executes and synthesizes analytics and artificial intelligence solutions to support and address specific audit questions, programs and initiatives. Responsible for synthesizing large volumes of structured/unstructured data and applying AI techniques on top of it in order to bring high quality solutions to solve the problems. This incumbent will draw on tools and methods from big data, business intelligence, statistics, and artificial intelligence to do data modeling, ETL, text mining, topic modeling, natural language processing, machine learning, cognitive computing, pattern recognition, robotic process automation, predictive modeling, data visualization and drive projects through to delivery of the intended outcome. Continuously scans and tests new data sources, tools, analytical techniques, advanced AI methodologies and partners with leading vendors and experts to contribute to our portfolio of next-generation Artificial Intelligence projects.
- Work directly with the Audit & Compliance business to understand audits, questions, business processes, programs and/or initiatives, then identifying how analytical, big data and AI solutions could help deliver value for audits and saving healthcare from fraud, waste, abuse activities. This would include being accountable for, outlining new use cases, creating high level impact estimates, and identifying the necessary data elements (including proxies) to deliver analytical solutions to complex business problems using AI methodologies. This job will be responsible to assemble data sets using appropriate source data/data systems and using AI techniques on that data.
- Perform data modeling, extractions, transformations, loads, integrations, processing and mining using relational database as well as Big data technologies for data readiness. Select and apply the appropriate artificial intelligence techniques on these data sets to deliver high quality business insight, ensuring that the final analytical solution is well researched, accurate, and documented. This requires technical flexibility, in-depth knowledge and delivery of advanced analytical solutions with the capability of predictive analytics, decision making and casual inference using various techniques including regression models, clustering techniques, tree-based learning, machine learning, text mining, topic modeling, natural language processing, cognitive analytics, neural networks, optical character recognition, pattern recognition, computer vision, RPA etc...
- Consult with the internal business to contextualize and translate the results of our analysis in a form which the business understands and the audit function can complete required audits. The incumbent is responsible for creation of written reports, presentation and data visualizations that draws clear lines between the high-level problem specifications, the analyses performed, and how the results link directly back to business and/or audit objectives.
- Plan, prepare, initiate and complete all modeling/analyses on time, to a high standard and ready to implement on a production basis as needed/accepted by the organization. In addition, responsibilities include identifying the best route to the implementation of proposed solution, inclusive of developing the appropriate AI solution. This position is also responsible for automating the manual interventions in audit and financial investigation areas by creating solutions through application automation, robotic process automation as per the necessity.
- Research new AI skills, approaches and trends, to facilitate building relationships internally and externally to transfer knowledge, consult and maintain their subject matter expertise. Consult and collaborate with fellow artificial intelligence scientists, data scientists, business intelligence engineers, decision support consultants and analysts to guide analysis and deliver larger projects.
- Other duties as assigned or requested.
- Master's Degree in Mathematics, Statistics, Operations Research, Information Technology, Computer Science, Engineering or Artificial Intelligence
Bachelor’s Degree in any of Mathematics, Statistics, Operations Research, Information Technology, Computer Science, Engineering or Artificial Intelligence with three (3) years of post-baccalaureate and progressively responsible experience in a related position.
- 3 - 5 Years of Total Experience
- Data Modeling, Warehousing and Engineering
- Big Data Technologies with Hadoop Ecosystem
- Data Mining, Data Visualizations, Statistical Analysis and Predictive Modeling
- Building Artificial Intelligence Solutions using Machine Learning, Neural Networks, Text mining, Topic modeling, Natural Language Processing, Pattern Recognition, Robotic Process Automation and Cognitive Analytics, or combination thereof.
- 1 year in the Healthcare Industry
- 1 year with Research and Development, Operations, or IT Audit function
LICENSES or CERTIFICATIONS
- Academy for Health Care Management Professional (PAHM)
- Alteryx or SAS or Tableau or any other BI/Analytics Tool
- Machine Learning
- Analysis of business problems/needs
- Analytical and Logical Reasoning/Thinking
- Collaborative Problem Solving
- Data Modeling/ETL/Mining and Statistical Analysis
- SQL, SAS, R, Alteryx and Tableau
- Big Data and Hadoop Ecosystem
- One among the programming languages: Python, Java, Scala
- Data visualizations, analytics, including the development and use of data-driven predictive models
- AI including Machine Learning, Deep Learning, Text Mining, Topic Modeling, NLP, Pattern Recognition, Cognitive Analytics and RPA
- Demonstrated knowledge of concepts of power analysis, hypothesis testing, inference
- Healthcare Domain Experience
- Written and Oral Presentation Skills
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Does Not Apply
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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