Data Scientist
About The Position
The Data Scientist develops advanced analytical models, algorithms, and data pipelines to support proactive fraud, waste, and abuse detection across Medicare and Medicaid programs. This role leads the design and implementation of predictive models, simulations, and data‑driven solutions that enhance program integrity efforts. The Data Scientist collaborates across the organization to identify analytic opportunities, interpret complex datasets, and produce actionable insights. In addition to executing high‑level analytical work, the Data Scientist serves as a technical lead, supports multiple projects simultaneously, mentors data analysts, and assists management with specialized tasks and strategic initiatives. In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity System's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
Requirements
- Expert knowledge of healthcare claims data including Medicare, Medicaid, ICD‑10‑CM, provider identifiers, and reimbursement structures
- Knowledge of Medicare and Medicaid claims processing and program integrity principles
- Proficiency in data science programming languages such as Python, R, and SQL, with the ability to write clear, reproducible code
- Knowledge of machine learning techniques including clustering, decision trees, neural networks, and anomaly detection
- Knowledge of advanced statistical and data mining techniques such as regression, distribution analysis, statistical testing, and social network analysis
- Strong critical‑thinking and problem‑solving skills for evaluating complex datasets and identifying meaningful patterns
- Exceptional verbal and written communication skills for presenting technical findings to diverse audiences
- Ability to manage multiple and conflicting priorities across concurrent projects
- Proficiency with Microsoft Word, Excel, and PowerPoint for documentation and presentation
- Bachelor’s degree in Mathematics, Statistics, Data Science, Healthcare Administration, Computer Science, Public Health, or a related quantitative field required; preference given to candidates with post‑graduate coursework or an advanced degree.
- At least 5 years of experience performing data analysis and modeling using SQL, Python, or R.
- At least 3 years of experience applying statistical and data mining techniques and developing machine learning algorithms.
- At least 3 years of experience analyzing Medicare, Medicaid, or healthcare claims data.
- Experience working in cloud environments such as Databricks, Snowflake, Microsoft Azure, or Amazon Web Services.
Nice To Haves
- preference given to candidates with post-graduate coursework or an advanced degree.
Responsibilities
- Lead the development of advanced analytical, predictive, and statistical models by defining data requirements, designing algorithms, and validating model performance
- Apply machine learning and modeling techniques to identify potential fraud, waste, and abuse in Medicare and Medicaid claims
- Develop insights, reports, and visualizations that translate complex data into clear, actionable findings
- Design, implement, and automate data pipelines and reporting solutions to support proactive analytics and operational efficiency
- Develop tools and processes to monitor model performance, data quality, and data accuracy
- Support data analysis teams by developing ad hoc techniques, providing technical guidance, and assisting with complex analytic challenges
- Collaborate with internal and external stakeholders to communicate findings and support investigative and operational needs
- Ensure compliance with PIM guidelines and CMS direction related to data analysis and data management
- Prepare and submit required reports within established timeframes
- Maintain documentation and reporting standards to support transparency, reproducibility, and audit readiness
- Identify opportunities for process improvement and advocate for enhancements to analytic workflows and tools
- Perform other duties as assigned in support of program integrity and organizational goals
Benefits
- Medical, Dental, Vision plans
- Life, LTD and STD paid by the employer
- 401(k) with company match up to 4%
- Paid Time Off and company paid holidays
- Tuition assistance after 1 year of service
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
