Senior Manager, Program Integrity, Data Science

Data ScientistData ScientistFull TimeRemoteTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

86 days ago

Salary

$110.8K - $193.8K / year

Bachelor Degree6 yrs expExperience acceptedEnglishAWSAzureCloudGoogle Cloud PlatformPython

Job Description

• Oversee and manage an ever-changing portfolio of claim-centric algorithms that identify claims pre and post-pay • Responsible for providing depositions and testifying in court to support legal actions initiated by CareSource and the Attorney General • Collaborate with cross-functional teams to solve Program Integrity problems, develop new algorithms and models, and identify trends and opportunities • Lead a team of data scientists and statisticians to develop and drive innovative approaches to increase PI effectiveness and efficiency • Monitor and provide explanation of anomalies related to trends associated with the potential for Fraud Waste and Abuse across the corporate enterprise

Job Requirements

  • Bachelor's degree in Data Science, Mathematics, Statistics, Criminal Justice, Medical/Health Care Field, or another related field required
  • Master's degree in Data Science, Mathematics, Statistics, Criminal Justice, Medical/Health Care Field, or another related field preferred
  • Six (6) years Data Science, Health Care, Legal, Auditing, Claims and/or Investigative Services required
  • One (1) year Cloud Services (such as Azure, AWS or GCP) and modern data stack (such as Databricks or Snowflakes) required
  • Two (2) years of leadership/supervisory experience required
  • Strong expertise in statistical modeling, machine learning techniques, and predictive analytics tools such as Python, or R
  • Proficiency with MS office (Excel, PowerPoint, Word, Access)

Benefits

  • Comprehensive total rewards package

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