Title: VP of Enterprise AI & Advanced Analytics
Location: Schenectady, NY
Length: Permanent Position
VP of Enterprise AI & Advanced Analytics roles at healthcare payers and services companies emphasize AI-driven strategies to optimize claims processing, risk adjustment, and member engagement while controlling costs. This version positions the role for organizations like managed care providers or payer services firms, integrating health economics and n-of-1 hyper-personalization.
Key Responsibilities
• Spearhead AI initiatives for payer priorities, including predictive risk modeling for HCCs, fraud detection, and utilization management using claims and social determinants data.
• Advance health economics through cost-effectiveness analyses, value-based contracting, and real-world evidence for formulary decisions and provider network optimization.
• Pioneer n-of-1 methodologies for hyper-personalized member interventions, deploying AI/ML to tailor care plans via wearables, telehealth, and behavioral nudges for chronic conditions.
Required Qualifications
• 10+ years in payer analytics leadership, with expertise in health economics (ICER, QALYs), claims datasets, and AI personalization in managed care environments.
• Master''s/PhD in health informatics, economics, data science, or related; experience with payer platforms like Facets, QNXT, or EHR integrations.
• Proven success in payer digital transformation, driving ROI through AI for member retention, STAR ratings, and regulatory compliance (HIPAA, CMS).
Essential Skills
• Mastery of AI/ML for payer use cases: NLP on prior authorizations, deep learning for risk stratification, and generative AI for personalized outreach.
• Strong command of health economics tools (budget impact models, HEOR), n-of-1 trial design, and tech stack (Python, SQL, TensorFlow, cloud analytics).
• Strategic communication to influence C-suite, actuaries, and providers on data-driven payer strategies for affordability and outcomes.
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