Data Scientist II - Fraud, Waste and Abuse

Centene Corporation•Washington, DC

1d•$87,700 - $157,800•Hybrid

About The Position

Centene is seeking a Data Scientist II to focus on Fraud, Waste, and Abuse (FWA) detection. This role involves developing scalable software solutions using statistical, AI, and ML modeling approaches. The position requires identifying and utilizing data sources, researching and testing algorithms, and integrating, testing, tuning, and monitoring solutions. The Data Scientist will design data models to predict member outcomes, construct analysis tools, conduct exploratory data analysis, and evaluate experiments. They will also develop mathematical and statistical models, participate in presentations, and design automated analytics processes. A key responsibility includes validating and measuring the outcomes of health management programs using tools like SAS and R, managing multiple projects, and assisting with training Data Analysts.

Requirements

Master’s degree in Statistics, Mathematics, Computer Science, Informatics, Econometrics, Engineering, Experimental Science with 3+ years of experience OR a Bachelor’s degree and 5+ years of quantitative analysis experience in data science capabilities including data mining, predictive modeling, machine learning, statistical modeling, large scale data acquisition, transformation, and structured and unstructured data analysis
Experience in fraud/waste/abuse identification and investigation, provider billing, or clinical coding preferred.
Knowledge of statistical analysis
Knowledge of building predictive models
SQL experience writing queries against complex relational databases
Experience with cloud computing environments, Spark, creating database schemas, continuous integration/continuous deployment, SQL, Python, REST APIs
Experience building ML/AI models using common methods within Python
Knowledge of JIRA and AGILE methodologies
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Nice To Haves

Knowledge of Home Health/Hospice and/or Behavioral Health billing, typical practice, and areas of potential FWA preferred.

Responsibilities

Develops scalable software solutions utilizing statistical, artificial intelligence (AI) and machine-learning (ML) modeling approaches in support of Fraud, Waste, & Abuse (FWA) detection.
Identifies, accesses, compiles, and uses internal and external sources of relevant data.
Performs research and testing to develop machine learning algorithms and predictive models.
Conducts and reviews model training and evaluation.
Integrates, tests, tunes, and monitors solutions.
Design and develop data models to predict member outcomes or future impact of key member decisions.
Design and construct analysis tools that extract, and analyze data and store analytical results in an appropriate format for business needs.
Conduct exploratory data analysis from complex data sources and build key data sets to support Centene’s mission.
Evaluate and design experiments to monitor key metrics and identify improvement opportunities.
Develop mathematical and statistical models to distinguish relevant content or events and recognize patterns.
Participate in presentations and communicate results of analysis and findings.
Participate in the design of automated, operational analytics processes to achieve scale and durability of analysis processes.
Validate and measure the outcomes of health management programs using SAS, R and other tools, to include provider data, claims data, membership data
Manage multiple projects as assigned.
Assist with training Data Analysts.