The Senior Manager, Program Integrity Data Science will oversee the Program Integrity Data Science team, serving as both a subject matter expert and a mentor. This role is accountable for designing and implementing algorithms that identify claims for intervention (audit, downcode, edit, etc.) – driving claim payment accuracy and mitigating fraud, waste, and abuse (FWA) within CareSource health plans. Essential Functions: Oversee and manage an ever-changing portfolio of claim-centric algorithms that identify claims pre and post-pay that can be moved into various workflows for intervention – including a request for medical record and audit (correct coding and medical necessity), a downcode to revised reimbursement, etc. Algorithms will vary from rule / criteria-based solutions to probabilistic scoring / statistical solutions and will include a ranking of relative value / likelihood of fraud, waste, or abuse. Hands-on management of data science function, including technical development and / or direct oversight of technical work product developed by the team. Responsible for providing depositions and testifying in court to support legal actions initiated by CareSource and the Attorney General. Assist in the deployment of advanced analytic solutions into the various functions within Program Integrity (Investigations, Regulatory, Audit, Prepay, etc.). Conduct outcome analyses to determine impact and effectiveness of corporate and Special Investigations Unit (SIU) initiatives. Translate complex healthcare policies into practical strategies that help identify and enhance opportunities for Program Integrity. Develop hypothesis tests and extrapolations on statistically valid samples to establish outlier behavior patterns and potential recoupment. Assist in the execution and support of various analytic studies that establish Program Integrity as a leader in FWA analytics across markets. Collaborate with cross-functional teams to solve Program Integrity problems, develop new algorithms and models, and identify trends and opportunities. Manage all efforts of your analytics team focusing on thorough but timely investigations, highest impact prioritization, root cause identification, statistical evidence development and investigative actions. Use descriptive statistical techniques to measure impact of various actions/studies, internal and external, develop sampling and hypothesis testing to help the organization determine outcomes. Lead a team of data scientists and statisticians to develop and drive innovative approaches to increase PI effectiveness and efficiency. Develop and implement predictive models, algorithms, and statistical techniques to extract insights from large and complex healthcare datasets. Utilize machine learning algorithms to identify patterns, trends, and opportunities for improving operational efficiency, cost containment, and patient care. Monitor and provide explanation of anomalies related to trends associated with the potential for Fraud Waste and Abuse across the corporate enterprise. Stay abreast of emerging trends, tools, and techniques in predictive analytics, data science, and healthcare informatics to drive innovation and continuous improvement. Provide strategic guidance and recommendations to senior leadership based on data analysis and predictive modeling results. Mentor and develop team members, fostering a collaborative and innovative work environment. Ensure compliance with data privacy and security regulations and maintain the highest standards of data integrity. Perform any other job related duties as requested.