Vice President, Informatics

Verisk Health's Payment Accuracy Division provides both private and public healthcare payers with a suite of claims editing, fraud prevention and clinical validation solutions. Our real-time analytics platform delivers solutions in sub-second time that will improve auto-adjudication rates, claims processing efficiency, operations insight and cost containment. Our next-generation prepayment detection software, Nucleus, identifies suspect claims and billing patterns using predictive analytics, robust databases and link analysis in a SaaS model and a unique, productivity driven user-experience. Conducted by medical, coding and investigative experts, our clinical review process individually validates the accuracy of claim recommendations, serving to improve the quality of cases referred to SIUs. Through this comprehensive model of real-time editing, in-depth fraud analytics and clinical review, Verisk Health delivers their customers unequaled savings. Verisk Health is an equal opportunity employer.

Responsibilities:

• Establish an encompassing analytics vision spanning data warehousing, business intelligence, and predictive analytics competencies. Lead the conception and development of new predictive and descriptive modeling initiatives to infuse innovation and strategic differentiation into our product sets. Develop and implement effective data warehousing and business intelligence strategies to deliver organizational value.
• Drive the identification of new data sources and leverage of innovative techniques to continually enhance a multi-pronged system of fraud and abuse detection - including provider, patient, claim, and other perspectives.
• Establish strong working relationships with diverse business and client stakeholders, and promote ease of communication and collaboration. Create and maintain development roadmaps for all activities in the Informatics function. Interface with area leads and product managers to ensure business-driven prioritization and deployment of analytical activities. Serve as the primary business contact for questions/clarifications on Analytics development progress. Develop analytical highlights and feature blurbs to aid Marketing in branding and collateral development and contribute to the development of pitch documents and demos.
• Establish technical best-practices for data management, reporting, analysis, modeling, and validation. Develop and launch effective processes for prioritizing, resourcing, developing, validating, and deploying analytical solutions and reporting functionalities. Establish budgets and KPIs for the team and manage to results.
• Attract, hire, develop, and retain top talent across all functional areas including data warehousing, business intelligence, and predictive analytics.
• Create publications including technical reports, white papers and byline articles. Actively promote Verisk products by attending and speaking at conferences as appropriate. Keep abreast of research literature and business trends to keep the company at the leading edge of solution efficacy and innovation.

• Masters degree in a quantitative or actuarial field is required. PhD is strongly preferred.
• 10+ years of professional experience building predictive models on very large datasets is required. Academic experience at the PhD level could be partially substituted for professional experience.
• 5+ years of experience leading analytical/quantitative teams with responsibilities for innovation and practical business solutions is required.
• Extensive experience in applying a range of predictive modeling techniques to develop fraud-detection solutions is required. Experience in the healthcare vertical is preferred.
• Strong analytical vision and demonstrated ability to lead innovative initiatives and cross-functional teams is required.
• Demonstrated expertise with broad range statistical and predictive modeling techniques (e.g., GLM/Regression, Trees, Neural networks, etc.) is required.
• Experience with emerging techniques such as Network mining, Text mining, Geo-spatial analytics, etc. is required.
• Ability to lead data and business intelligence functions is required, with demonstrated experience strongly preferred.
• Extensive experience with statistical analysis and modeling software such as SAS, IBM SPSS, Statistica, or R is required. Experience with data mining platforms such as SAS Enterprise Miner, IBM SPSS Modeler, Statistica Data Miner, or equivalent is preferred.
• Excellent verbal and written communication skills are required, including ability to present to senior executives as well as in public forums and conferences.
• Demonstrated ability to work with diverse business and client stakeholders is required.
• Demonstrated ability to attract, hire, develop, and retain strong talent is required.

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