Data Scientist II - Fraud, Waste and Abuse

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Position Purpose:

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.

Knowledge/Experience:

• Requires a 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

• Fraud, Waste & Abuse Experience: Experience in fraud/waste/abuse identification and investigation, provider billing, or clinical coding preferred. Knowledge of Home Health/Hospice and/or Behavioral Health billing, typical practice, and areas of potential FWA preferred.

Technical Skills:

• 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

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act