Director of Enterprise Data Modeling

Abacus Insights is a mission-driven, growth-stage technology company focused on transforming the healthcare industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats, allowing our customers to uncover differentiated insights that address their client's needs. In addition, our employees know that they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met. 

With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payers access to historically siloed and inaccessible data. Through our platform, these healthcare organizations can ingest and manage all the data they need to transform their business by supporting their analytical, operational, and financial needs. 

Since our founding in 2017, Abacus has built a highly successful SaaS business, raising more than $81 Million from leading VC firms with deep expertise in the healthcare and technology industries. We are solving problems of massive scale and complexity in a sector ready for disruption. We're growing quickly and would love for you to be a part of it! 

About the Role:

We are seeking a Director of Enterprise Data Modeling to lead the strategy, governance, and implementation of a comprehensive healthcare data model that powers our next-generation cloud-based data platform.

• Focus on building a productized unified enterprise data model that supports all client implementations, ensuring scalability, reusability, and efficiency.
• Develop an enterprise foundational data model that can integrate data from disparate sources while supporting both operational and analytical needs.
• Design and implement standard Subject Area Marts to power various data products and solutions such as HEDIS, Risk Adjustment, Provider Data Management, CMS InterOp, and more. 

This role will serve as a business-facing healthcare data expert, engaging with client executives, business and technical leads, product teams, and engineering leaders to define and communicate data model constructs across:

• Core Administrative Data – Claims, Membership, Enrollment, Provider
• Clinical & Interoperability Data – FHIR, HL7, ADT, CCDA
• Financial & Operational Data – Billing, Premiums, Actuarial & Risk Adjustment
• Regulatory & Compliance Data – T-MSIS, HEDIS, CMS Reporting 

As a trusted advisor to client executives and stakeholders, you will translate complex payer, provider, and interoperability data structures into a business-friendly framework that supports analytics, operational workflows, and regulatory compliance. 

This role will also lead a global data modeling team, ensuring the development of logical and physical data models aligned with modern cloud technologies like Databricks and Snowflake.

You will: 

Healthcare Data Strategy & Client Engagement

• Act as the healthcare data subject matter expert (SME), advising client executives, business and technical leads, and internal teams on data architecture, interoperability, and business-driven data use cases.
• Define and evangelize a unified data model strategy for payer, provider, and regulatory datasets, ensuring alignment with FHIR, HL7, claims, billing, HEDIS and risk adjustment standards.
• Engage with healthcare business and technical leaders to identify data needs, key metrics, and business rules that drive better decision-making and operational efficiency.
• Develop and present executive-level roadmaps, whitepapers, and solution overviews that communicate our data model framework and business impact.
• Collaborate with client implementation teams to understand client-specific requirements, address issues/concerns, and assess the overall data model impact, ensuring it evolves to meet client and industry demands for a more efficient client implementation process. 

Data Modeling & Architecture Leadership

• Oversee the design, governance, and optimization of data models across payer, provider, financial, and clinical domains.
• Lead an offshore data modeling team, ensuring high-quality ERD development, metadata management, and data transformation strategies.
• Define data attributes, relationships, cardinality, and quality rules to support data ingestion, analytics, and operational reporting.
• Continuously enhance the data model to support evolving client needs and industry trends, ensuring a scalable and adaptable healthcare data platform. 

Data Platform & Engineering Collaboration 

• Work closely with product management to translate business needs into technical specifications, including epics, user stories, and acceptance criteria.
• Drive data governance and security best practices to ensure compliance with HIPAA, CMS, and NCQA regulations. 

What we're looking for: 

• 12+ years of experience in healthcare data strategy, architecture, or data modeling, with expertise in payer, provider, and regulatory data domains.
• 7+ years of experience engaging with client executives, business and technical leads, and healthcare stakeholders in data strategy discussions.
• Proven expertise in claims, membership, provider, billing, enrollment, and interoperability data models (FHIR, HL7, CCDA, ADT).
• Strong data modeling and governance skills, with experience using ER/Studio, DBSchema, Erwin, or similar tools.
• Hands-on experience with modern cloud data platforms (Databricks, Snowflake,) and ETL/ELT pipeline design.
• Experience working with client implementation teams to assess data model impact, address challenges, and evolve data models for improved implementation efficiency.
• Exceptional ability to translate business needs into data models that support analytics, actuarial analysis, care management, and regulatory reporting.
• Outstanding communication skills, with the ability to present complex data models

Equal Opportunity Employer 

As a mission-led technology company that is helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. We are dedicated to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment of any type in regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.