The Prospective Risk Adjustment Operations team is seeking a highly analytical and technically proficient Director to lead advanced data science initiatives that drive strategic performance in prospective risk adjustment. This leadership role is accountable for designing and executing complex analytic strategies-including benchmarking, prevalence tracking, cohort stratification, predictive modeling, and suspecting logic-to optimize risk capture and support clinical and operational decision-making. The Director will bring deep domain expertise in CMS-HCC and HHS-HCC & RXC frameworks, with a strong understanding of chronic vs. acute coding implications, recapture logic, and disease prevalence trends. A critical focus will be on developing scalable analytic solutions that inform member targeting, provider engagement, and program compliance, while translating complex data into actionable insights. This role demands fluency in SQL, SAS, or Python to drive data extraction, validation, and advanced analytics, as well as a strong grasp of healthcare claims data-including ICD, CPT/HCPCS, bill type, and revenue codes-and familiarity with risk adjustment submission systems such as EDPS and EDGE. The ideal candidate will be proficient in statistical modeling, regression analysis, variance normalization across markets, and ACA payment transfer modeling. Expertise in hypothesis testing and significance interpretation is essential to support critical thinking and insight generation. The Director will be responsible for synthesizing complex findings into clear, compelling narratives that support strategic decision-making and stakeholder alignment. Experience in government-sponsored health programs such as Medicare Advantage or ACA is strongly preferred. This director level position is primarily responsible for directing and influencing strategic data-informed decision making, overseeing data and information collection on targeted variables in an established systematic fashion, and directing data preparation for analytic efforts. This position oversees the execution of creative data analytic approaches leading to actionable outcomes across one or more functional areas, business and/or clinical lines, oversees the development, implementation, and automation of business and reporting strategies, and oversees data analysis interpretation.