About the Role
We are seeking a Principal Data Scientist to lead the design, maintenance, and annual evolution of risk assessment and compliance analytics solutions supporting CMS Marketplace oversight programs. This role sits at the intersection of regulatory data science, risk modeling, and federal program oversight driving the analytical frameworks used to evaluate and prioritize compliance risk across QHP issuers, web brokers, agents/brokers, and Direct Enrollment (DE/EDE) entities.ย
What You Will Do
ยทย ย ย ย ย Lead development and ongoing refinement of structured risk assessment methodologies, including changes to data sources, measure design, risk attribution logic, and scoring calculations.
ยทย ย ย ย ย Design and develop compliance risk dashboards and performance monitoring tools adopted by CMS policy and audit stakeholders for operational decision-making, leveraging data visualization platforms such as Power BI, Tableau, or MS Excel.
ยทย ย ย ย ย Design data-driven methodologies to identify and quantify compliance risk using multi-source datasets, including the preparation and maintenance of composite measure frameworks and multi-stage risk scoring pipelines.
ยทย ย ย ย ย Support issuer compliance reviews, DE/EDE audits, and agent/broker oversight activities by translating regulatory requirements into technical specifications and testable data logic.
ยทย ย ย ย ย Develop AI and machine learning solutions with explainability to prioritize and detect noncompliance, and implement agentic AI workflows that automate ingestion, validation, and normalization of compliance data.
ยทย ย ย ย ย Support development and maintenance of machine-readable public use files (PUFs) and associated validation logic.
ยทย ย ย ย ย Integrate and harmonize CMS data systems to produce actionable insights and executive reporting, ensuring risk scoring outputs are clearly communicated to non-technical and senior stakeholders.
ยทย ย ย ย ย Collaborate with CMS policy, audit, and IT teams to continuously enhance oversight systems and analytical processes.
What We Are Looking For
ยทย ย ย ย ย Bachelorโs degree (Masterโs preferred) in Data Science, Computer Science, Information Systems, Statistics, Public Health, Health Informatics, or related field.
ยทย ย ย ย ย 5+ years of hands-on experience in advanced analytics or data science within regulated environments such as healthcare, insurance, government, or financial services.
ยทย ย ย ย ย 3+ years of experience leading technical or cross-functional teams.
ยทย ย ย ย ย Proven experience building risk scoring methodologies, predictive models, or compliance analytics frameworks involving multi-source datasets.
ยทย ย ย ย ย Proficiency in Python and/or R, SQL, and structured data analysis (SAS experience a plus) and experience using Databricks.
ยทย ย ย ย ย Experience working with large, complex, multi-source datasets.
ยทย ย ย ย ย Expert-level proficiency in data visualization platforms (Power BI, Tableau, or MS Excel) with demonstrated experience producing dashboards for senior and non-technical stakeholders in a regulatory or federal program environment.
ยทย ย ย ย ย Strong ability to communicate technical methodology and findings clearly to non-technical and executive stakeholders.
ยทย ย ย ย ย Ability to pass a background investigation or federal security clearance for contracted project work; holding an active CMS Enterprise User Administration (EUA) ID is desired.
Preferred Experience
ยทย ย ย ย ย Experience supporting CMS, CCIIO, ACA Marketplace, or other federal oversight programs.
ยทย ย ย ย ย Familiarity with QHP compliance reviews, DE/EDE, or agent/broker oversight, agent/broker oversight, or the ACA regulatory framework.
ยทย ย ย ย ย Experience developing explainable AI or human-in-the-loop decision support tools.
ยทย ย ย ย ย Experience with methodology documentation, SOP development, or audit-ready analytical frameworks