Leads healthcare payer data science and modernization initiatives, developing predictive models, statistical analyses, and scenario-based insights from claims, reimbursement, utilization, and member experience data. Directs multiple analytical workstreams, advises executive clients, guides cross-functional teams, supports transformation roadmaps, and promotes responsible AI use. The role also shapes thought leadership, business growth, operational improvement, and delivery quality across payer advisory engagements.
The Opportunity
As a Payer Healthcare Data Scientist you will lead data science efforts within our Advisory practice, focusing on payer modernization work that improves core operations, platform execution, and member experience across healthcare organizations. As a Director you will set direction for multiple work streams, shape executive client relationships, drive business growth, and guide teams in using data, technology, and industry insight to develop new ideas and solutions.
In this role at PwC, you will apply advanced analytic methods to healthcare payer data, translate business questions into data-driven approaches, and present findings that support decisions across claims, care management, digital experience, and operating model transformation. You will also help identify market needs, develop thought leadership, and contribute to delivery quality across engagements tied to the Payer Modernisation offering, within our Advisory practice and aligned to the Health Services sector and Business & Supply Chain Operations network.
Responsibilities
- Leading payer modernization data science initiatives that inform strategy, improve operations, and support client growth
- Developing predictive models, statistical analyses, and scenario-based insights for healthcare payer operations and platform decisions
- Translating business questions into analytical approaches using AI fluency, digital tooling, and business data analytics
- Synthesizing claims, reimbursement, utilization management, and customer experience data into actionable findings
- Presenting findings and recommendations to executive client leaders through clear data narratives and visual storytelling
- Overseeing multiple analytical workstreams across core systems, front office, middle office, and operational process improvement efforts
- Guiding technical teams in the use of payer platforms such as Oracle OHI, Epic, Facets, and Nasco
- Applying operations strategy, process optimization, and business performance metrics to identify efficiency opportunities
- Collaborating across strategy, technology, and risk functions to support transformation roadmaps and implementation planning
- Advising on data quality, analytical methods, and responsible use of AI in healthcare payer environments
What You Must Have
- At least a Bachelor's degree
- At least 10 years of experience
What Sets You Apart
- Preference for at least one of the following fields of study: Accounting, Actuarial Science, Analytics/Data Science, Business Administration/Management, Computer Science/Information Systems, Economics, Engineering, Finance, Government/Public Policy, Health Administration/Public Health, Mathematics/Statistics, Operations/Supply Chain, Organizational Management/Behavior, Risk Management/Insurance
- Demonstrating payer modernization analytics within health services settings
- Applying business data analytics to operational transformation initiatives
- Using predictive modeling and statistical methods for payer decisions
- Translating data insights into executive recommendations and action
- Guiding cross-functional teams through change and process improvement
- Communicating findings clearly to clients and leadership teams
The salary range for this position is: $155,000 - $410,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glance
As PwC is an equal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law.
PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.
Learn more about how we work: https://pwc.to/how-we-work
For only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.
Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlines
As a Payer Healthcare Data Scientist you will lead data science efforts within our Advisory practice, focusing on payer modernization work that improves core operations, platform execution, and member experience across healthcare organizations. As a Director you will set direction for multiple work streams, shape executive client relationships, drive business growth, and guide teams in using data, technology, and industry insight to develop new ideas and solutions.
In this role at PwC, you will apply advanced analytic methods to healthcare payer data, translate business questions into data-driven approaches, and present findings that support decisions across claims, care management, digital experience, and operating model transformation. You will also help identify market needs, develop thought leadership, and contribute to delivery quality across engagements tied to the Payer Modernisation offering, within our Advisory practice and aligned to the Health Services sector and Business & Supply Chain Operations network.
Responsibilities
- Leading payer modernization data science initiatives that inform strategy, improve operations, and support client growth
- Developing predictive models, statistical analyses, and scenario-based insights for healthcare payer operations and platform decisions
- Translating business questions into analytical approaches using AI fluency, digital tooling, and business data analytics
- Synthesizing claims, reimbursement, utilization management, and customer experience data into actionable findings
- Presenting findings and recommendations to executive client leaders through clear data narratives and visual storytelling
- Overseeing multiple analytical workstreams across core systems, front office, middle office, and operational process improvement efforts
- Guiding technical teams in the use of payer platforms such as Oracle OHI, Epic, Facets, and Nasco
- Applying operations strategy, process optimization, and business performance metrics to identify efficiency opportunities
- Collaborating across strategy, technology, and risk functions to support transformation roadmaps and implementation planning
- Advising on data quality, analytical methods, and responsible use of AI in healthcare payer environments
What You Must Have
- At least a Bachelor's degree
- At least 10 years of experience
What Sets You Apart
- Preference for at least one of the following fields of study: Accounting, Actuarial Science, Analytics/Data Science, Business Administration/Management, Computer Science/Information Systems, Economics, Engineering, Finance, Government/Public Policy, Health Administration/Public Health, Mathematics/Statistics, Operations/Supply Chain, Organizational Management/Behavior, Risk Management/Insurance
- Demonstrating payer modernization analytics within health services settings
- Applying business data analytics to operational transformation initiatives
- Using predictive modeling and statistical methods for payer decisions
- Translating data insights into executive recommendations and action
- Guiding cross-functional teams through change and process improvement
- Communicating findings clearly to clients and leadership teams
The salary range for this position is: $155,000 - $410,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glance
As PwC is an equal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law.
PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.
Learn more about how we work: https://pwc.to/how-we-work
For only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.
Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlines
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