UnitedHealth Group-posted 9 months ago
$71,600 - $140,600/Yr
Full-time • Mid Level
Remote • San Antonio, TX
Insurance Carriers and Related Activities

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together. The Data Scientist is responsible for providing analytic support to identify and address areas of potential fraud, waste, and abuse. Under limited supervision, they will access, analyze, and visualize administrative health care data from a variety of internal and external data sources, using the results to recommend next steps and prioritize areas of focus. This role will work closely with clinical and operational partners, translating complex analytic results into actionable insights. This position leverages a variety of analytic programming languages, including SQL and R to query databases, build dynamic/interactive visualizations and applications, conduct statistical sampling, etc.

  • Identifies and investigates areas of potential payment integrity concern, including responding to ad hoc requests for data analysis, recurring data mining and monitoring, and proactive analytic initiatives
  • Designs, develops, tests, and maintains database queries and reports (SQL and Oracle)
  • Leverages R for analytic visualization, time series analysis, statistical sampling, and web application development using Shiny
  • Assists in statistical and machine learning functions and makes recommendations on processes, including: sample size and power calculations, sampling and extrapolation, clustering and outlier detection, and longitudinal analyses
  • Assists in designing, developing, and implementing web applications and analytic tools, including Salesforce and Posit Professional Products (RStudio Connect)
  • Follows best practices for documentation and code versioning using GIT
  • Develops project timelines, communicates with customers to meet project deliverables and customer expectations
  • Serves as a resource to operational claims and clinical staff, answering questions and assisting with department informatics, reporting and trending, and workflow/operational issues
  • Supports the creation and execution of strategies to recover identified overpayments and prevent future overpayments
  • Defines and develops cost avoidance measures to measure ongoing progress and ensure continued success
  • 3+ years of experience in a professional (non-academic) environment accessing, manipulating, and analyzing data stored in structured databases using SQL
  • 3+ years of experience in a professional (non-academic) environment using R for data cleaning, wrangling, and feature engineering
  • Professional experience using data visualization to present complex insights to technical and non-technical audiences, including senior leadership
  • Expert knowledge of Excel
  • Experience with health plan or health care administration data, including the Medicare program
  • Experience with Salesforce development
  • Experience using GitHub to build codebases, version-control code, and collaborate
  • Familiarity with program or payment integrity initiatives
  • Proficient knowledge of R development, including experience with Shiny-based web application development
  • Comfort with statistical and machine learning libraries
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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