About the role

The Data Scientist will apply advanced analytics and machine learning methodologies to healthcare data to uncover actionable insights. They will develop predictive models for claims forecasting, fraud detection, and member segmentation to support strategic decision-making and cost optimization.

What they look for

Data Science Advanced Analytics SAS SQL Python R Power BI Databricks Predictive Modeling Claims Forecasting Fraud Detection Member Segmentation Utilization Analysis Statistical Analysis Machine Learning Data Visualization

Requirements

Candidates must be proficient in tools such as SAS, SQL, Python, R, and Power BI to process and interpret complex healthcare datasets. The role requires the ability to collaborate across business units to ensure data integrity and deliver value-driven insights for healthcare initiatives.

Full description

MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:

To apply advanced analytics and data science methodologies in the analysis of healthcare data, utilizing tools such as SAS, SQL, Python, R, Power BI, and modern platforms like Databricks. The goal is to uncover actionable insights that inform strategic decision-making, enhance risk assessment, and optimize costs. This role emphasizes the development of predictive models for claims forecasting, fraud detection, member segmentation, and utilization analysis. The Data Scientist will work collaboratively across business units to deliver value-driven insights and support value-based care initiatives aimed at improving utilization rates and overall healthcare outcomes.

Data Gathering & Research 1. Design and implement data collection strategies from internal systems and external sources. 2. Conduct exploratory research to identify relevant datasets and emerging trends in healthcare analytics. 3. Collaborate with cross-functional teams to define data requirements and ensure data quality and integrity. Data Analysis & Modeling Analyze complex healthcare datasets to identify trends, patterns, and anomalies. Develop and validate predictive models for claims forecasting, fraud detection, member segmentation, and utilization analysis. Apply statistical and machine learning techniques to support data-driven decision-making. Tool & Platform Utilization Leverage tools such as SAS, SQL, Python, R, Power BI, and Databricks to process, visualize, and interpret data. Automate data workflows and reporting processes to improve efficiency and scalability.

Business Collaboration Partner with various business units (BAUs) teams to understand analytical needs and translate them into actionable insights. Present findings and recommendations to stakeholders through clear visualizations and reports.

Strategic Support Contribute to value-based care initiatives by providing insights that improve utilization rates and healthcare outcomes. Support risk assessment and cost optimization strategies through data-driven analysis.

Quality & Compliance Ensure data integrity, accuracy, and compliance with healthcare regulations and standards. Maintain documentation of methodologies, models, and processes for transparency and reproducibility.You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.