Data Modeler with Medicare Advantage

Enterprise Data Modeler (Medicare Advantage)

Position Summary

We are seeking a highly experienced Enterprise Data Modeler to lead the development of enterprise and domain data models that will serve as the foundation of a strategic enterprise data transformation program.

This role will be responsible for creating and maintaining:

• Enterprise Business Data Models
• Canonical Data Models
• Logical Data Models
• Physical Data Models
• Domain Data Models across prioritized business domains

Critical Success Factors

Strong Business Domain Knowledge is Essential

This is not a traditional data modeling role focused solely on technical modeling.

The successful candidate must possess deep business domain expertise and be capable of translating complex business concepts into resilient enterprise data models.

The ability to facilitate discussions with business stakeholders and establish common business definitions is as important as technical modeling skills.

Medicare Advantage Experience is Mandatory

Candidates must demonstrate significant experience modeling data within the Medicare Advantage healthcare domain, including:

• Members and Enrollment
• Providers and Networks
• Claims and Encounters
• Authorizations and Referrals
• Care Management
• HEDIS and STARS
• Risk Adjustment (RAF/HCC)
• CMS Reporting
• Delegated and IPA Models
• Value-Based Care and Capitation

Candidates without Medicare Advantage data modeling experience will not be considered.

Required Skills & Experience

Data Modeling

• Enterprise Data Modeling
• Conceptual Data Modeling
• Canonical Data Modeling
• Logical Data Modeling
• Physical Data Modeling
• Domain-Driven Data Modeling
• Data Architecture Principles

Business & Facilitation

• Business Process Analysis
• Requirements Discovery
• Workshop Facilitation
• Business Glossary Development
• Data Stewardship Collaboration
• Cross-Functional Stakeholder Engagement

Data Management

• Master Data Management (MDM)
• Metadata Management
• Data Governance
• Data Quality Concepts
• Data Lineage Concepts

Modern Data Platforms

• Cloud Data Platforms
• Data Lakehouse Architectures
• Databricks or similar modern analytics platforms
• Data Product Concepts

Key Responsibilities

• Develop and maintain the Enterprise Business Data Model.
• Develop phased Domain Data Models aligned to enterprise standards.
• Collaborate with business and technical stakeholders to define core business entities and relationships.
• Establish canonical data structures across business domains.
• Align models with governance, metadata, MDM, analytics, AI, and reporting initiatives.
• Support implementation teams in translating business models into technical data solutions.

Ideal Candidate

A senior data modeler who combines:

• Strong enterprise data modeling expertise
• Deep Medicare Advantage business knowledge
• Excellent facilitation and stakeholder management skills
• Experience supporting large-scale enterprise data transformation initiatives

The ideal candidate understands that durable data models are built from a deep understanding of the business domain, not simply from source system structures.