Search Jobs | Dice.com

8 results (3 new)

Group by company

Program Integrity Data Scientist III

CareSource

Remote or Dayton, Ohio • Today

Full-time

USD 94,100.00 - 164,800.00 per year

Data Scientist IV

CareSource

Remote or Dayton, Ohio • Today

Full-time

USD 113,000.00 - 197,700.00 per year

Data Architect Lead

SAIC

Remote • Today

Full-time

USD 160,001.00 - 200,000.00 per year

Engineer III, Vulnerability Management

Cencora

Remote or Philadelphia, Pennsylvania • Today

Full-time

Senior Data Scientist, Trust (Inference)

Airbnb

Remote • Today

Full-time

USD 179,000.00 - 210,000.00 per year

Senior Data Science and Information Specialist (DSIS3/SPI)

Washington State Department of Transportation

Remote or Olympia, Washington • Today

Full-time

USD 105,612.00 - 142,020.00 per year

Senior Datadog Security & Observability Engineer

Keeper Security, Inc.

Remote • Today

Full-time

Lead Data Scientist IV - GEOINT/Remote Sensing

The Pacific Northwest National Laboratory

Remote or Richland, Washington • Today

Full-time

USD 166,800.00 per year

Job Details

Skills

Algorithms
Legal
Decision-making
IT Management
Workflow
Leadership
Decision Support
Research
Data Science
Mathematics
Computer Science
Cloud Computing
Microsoft Azure
Amazon Web Services
Google Cloud
Google Cloud Platform
Databricks
Snow Flake Schema
Auditing
Neural Network
SQL
Python
R
SAS
Dashboard
Reporting
Microsoft Power BI
Business Intelligence
Statistics
Testing
Predictive Modelling
Machine Learning (ML)
Deep Learning
Analytics
Clustering
Natural Language Processing
Data Analysis
Recovery
Health Care
Billing
Microsoft Excel
Microsoft PowerPoint
Critical Thinking
Presentations
Communication
Collaboration
Artificial Intelligence
Fraud
Mentorship
Analytical Skill
Coaching
System Integration Testing
Training
Partnership
Brand

Algorithms
Legal
Decision-making
IT Management
Workflow
Leadership
Decision Support
Research
Data Science
Mathematics
Computer Science
Cloud Computing
Microsoft Azure
Amazon Web Services
Google Cloud
Google Cloud Platform
Databricks
Snow Flake Schema
Auditing
Neural Network
SQL
Python
R
SAS
Dashboard
Reporting
Microsoft Power BI
Business Intelligence
Statistics
Testing
Predictive Modelling
Machine Learning (ML)
Deep Learning
Analytics
Clustering
Natural Language Processing
Data Analysis
Recovery
Health Care
Billing
Microsoft Excel
Microsoft PowerPoint
Critical Thinking
Presentations
Communication
Collaboration
Artificial Intelligence
Fraud
Mentorship
Analytical Skill
Coaching
System Integration Testing
Training
Partnership
Brand

Summary

Job Summary:

The Program Integrity Data Scientist III is responsible for leading the design, development, and deployment of advanced analytical solutions that support payment accuracy, anomaly detection, and Fraud, Waste, and Abuse (FWA) prevention and recovery efforts. This role serves as a senior analytical resource, providing technical leadership across complex investigations, predictive modeling initiatives, and enterprise program integrity strategies while mentoring junior analysts and data scientists.

Essential Functions:

Lead the design, development, and implementation of advanced algorithms that identify claims for pre- and post-payment intervention related to potential Fraud, Waste, and Abuse.
Analyze and quantify claim payment issues and provide recommendations to mitigate identified program integrity risks.
Identify emerging trends, risks, and patterns across multiple healthcare datasets and recommend strategic interventions to improve program integrity outcomes.
Mentor and provide technical guidance to analysts and data scientists through code reviews, analytical reviews, and best practice recommendations.
Evaluate emerging analytical, machine learning, and AI techniques to improve fraud detection, anomaly identification, and payment integrity efforts.
Conduct outcome analyses to determine impact and effectiveness of corporate program and payment integrity initiatives.
Lead the examination and interpretation of complex data relationships to support payment integrity, anomaly detection, and FWA investigations.
Lead monitoring and investigation of anomalies and emerging trends associated with potential Fraud, Waste, and Abuse activities across the enterprise.
Collaborate with the legal department, generating data and analyses to support legal proceedings.
Develop hypothesis tests and extrapolations on statistically valid samples to establish outlier behavior patterns and potential recoupment.
Lead development and communication of analytical strategies, project plans, methodologies, and investigative approaches for complex initiatives.
Design and develop advanced dashboards, visualizations, and reporting solutions that demonstrate model performance, program effectiveness, and program integrity outcomes.
Lead development of AI-enabled and business intelligence dashboards that support investigator workflows, fraud detection activities, operational monitoring, and executive decision-making.
Provide statistical validation and analysis of outcomes associated with clinical programs and interventions.
Provide technical leadership in integrating analytical solutions with enterprise systems, platforms, and operational workflows.
Present analytical findings, strategic recommendations, and program integrity insights to leadership and key stakeholders.
Lead preparation and deployment of production-ready analytical code, models, and automated decision-support solutions.
Research policy, billing guidelines, CMS direction and others to ideate new fraud, waste and abuse concepts to implement.
Perform any other job related duties as requested.

Education and Experience:

Bachelor's degree in Data Science, Mathematics, Statistics, Engineering, Computer Science, or a related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years data analysis and/or analytic programming required
One (1) year Experience with cloud services (such as Azure, AWS or Google Cloud Platform) and modern data stack (such as Databricks or Snowflake) preferred
Healthcare experience required
Experience supporting payment integrity, fraud detection, audit recovery, SIU, or program integrity initiatives preferred
Experience developing and applying deep learning, neural network, graph analytics, or graph neural network (GNN) solutions for fraud detection, anomaly identification, payment integrity, or healthcare analytics initiatives preferred

Competencies, Knowledge and Skills:

Advanced proficiency in SQL and at least one programming language such as Python or R
Familiarity with SAS is preferred
Proficient in designing and developing dashboards and reporting solutions using Power BI or similar business intelligence platforms
Ability to perform advanced statistical analyses and techniques including t-tests, ANOVAs, z-tests, statistical extrapolations, non-parametric significance testing, and sampling methodologies
Advanced knowledge of predictive modeling, machine learning, deep learning, neural networks, graph analytics, graph neural networks (GNNs), clustering, dimensionality reduction, anomaly detection, and natural language processing
Proficient in feature engineering techniques and exploratory data analysis
Ability to apply advanced analytical, artificial intelligence, and graph-based techniques to identify complex provider, member, claim, and organizational relationships associated with payment integrity, Fraud, Waste, and Abuse (FWA), anomaly detection, and recovery opportunities
Ability to analyze large quantities of information and identify patterns, irregularities, and deficiencies
Strong knowledge of healthcare coding, billing processes, reimbursement methodologies, claims adjudication and Program Integrity concepts.
Proficient with MS office (Excel, PowerPoint, Word, Access)
Demonstrated critical thinking, verbal communication, presentation and written communication skills
Ability to independently lead analytical initiatives and collaborate effectively across cross-functional teams
Familiarity with developing AI-enabled analytical solutions supporting fraud detection, anomaly identification, and payment integrity operations
Ability to mentor analysts and data scientists through analytical reviews, statistical guidance, and technical coaching

Licensure and Certification:

None

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time
Up to 15% (occasional) travel to attend meetings, trainings, and conferences may be required

Compensation Range:
$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):
Salary

Organization Level Competencies

Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GB1

Brand=CareSource

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: RTX11f1ed
Position Id: dc36d4b872de1717512e6e7cf99584c5
Posted 13 hours ago

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

Data Scientist II

Remote or Dayton, Ohio

•

Today

Job Summary: The Data Scientist II is responsible for designing and validating predictive models, machine learning models, and artificial intelligence that inform and improve business processes across the organization (operational, clinical, financial, marketing, etc.). Essential Functions: Create, maintain, and communicate an analytical plan for each projectMine and analyze large structured and unstructured datasetsEmploy wide range of data sources to develop algorithms for predicting risk an

Full-time

USD 83,000.00 - 132,800.00 per year

Senior Data Scientist

Remote

•

Today

The Senior Data Scientist provides advanced analytics, machine learning, and investigative data support. Working closely with criminal investigators, auditors, and technical stakeholders, this position develops and maintains predictive models, fraud detection methodologies, natural language processing (NLP) solutions, and analytical products designed to identify financial fraud, improper payments, and program noncompliance. The Senior Data Scientist transforms complex datasets into actionable in

Full-time

Data Specialist

Remote or Oklahoma

•

Today

Position Title: Data Specialist Department: Quality Data Reporting Job Description: Ask your recruiter about our competitive wages and total rewards package! Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. This position may be filled as levels II, or , depending on individual experience, education, certification(s), and business need. Ideal candidate will have Epic experience (Caboodle/Clarity) General Descriptio

Full-time

Sr. Healthcare Data Scientist (Medicare/Medicaid)

Remote

•

Today

Type of Requisition: Regular Clearance Level Must Currently Possess: None Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: NACI (T1) Job Family: Data Science and Data Engineering Job Qualifications: Skills: Agentic AI, Big Data, Generative AI, Machine Learning Methods, Python (Programming Language) Certifications: None Experience: 5 + years of related experience ship Required: No Job Description: We are GDIT. We take pride in providing our clients with the data t

Full-time

USD 97,968.00 - 132,250.00 per year

Job Details

Skills

Algorithms
Legal
Decision-making
IT Management
Workflow
Leadership
Decision Support
Research
Data Science
Mathematics
Computer Science
Cloud Computing
Microsoft Azure
Amazon Web Services
Google Cloud
Google Cloud Platform
Databricks
Snow Flake Schema
Auditing
Neural Network
SQL
Python
R
SAS
Dashboard
Reporting
Microsoft Power BI
Business Intelligence
Statistics
Testing
Predictive Modelling
Machine Learning (ML)
Deep Learning
Analytics
Clustering
Natural Language Processing
Data Analysis
Recovery
Health Care
Billing
Microsoft Excel
Microsoft PowerPoint
Critical Thinking
Presentations
Communication
Collaboration
Artificial Intelligence
Fraud
Mentorship
Analytical Skill
Coaching
System Integration Testing
Training
Partnership
Brand

Algorithms
Legal
Decision-making
IT Management
Workflow
Leadership
Decision Support
Research
Data Science
Mathematics
Computer Science
Cloud Computing
Microsoft Azure
Amazon Web Services
Google Cloud
Google Cloud Platform
Databricks
Snow Flake Schema
Auditing
Neural Network
SQL
Python
R
SAS
Dashboard
Reporting
Microsoft Power BI
Business Intelligence
Statistics
Testing
Predictive Modelling
Machine Learning (ML)
Deep Learning
Analytics
Clustering
Natural Language Processing
Data Analysis
Recovery
Health Care
Billing
Microsoft Excel
Microsoft PowerPoint
Critical Thinking
Presentations
Communication
Collaboration
Artificial Intelligence
Fraud
Mentorship
Analytical Skill
Coaching
System Integration Testing
Training
Partnership
Brand

Summary

Lead the design, development, and implementation of advanced algorithms that identify claims for pre- and post-payment intervention related to potential Fraud, Waste, and Abuse.
Analyze and quantify claim payment issues and provide recommendations to mitigate identified program integrity risks.
Identify emerging trends, risks, and patterns across multiple healthcare datasets and recommend strategic interventions to improve program integrity outcomes.
Mentor and provide technical guidance to analysts and data scientists through code reviews, analytical reviews, and best practice recommendations.
Evaluate emerging analytical, machine learning, and AI techniques to improve fraud detection, anomaly identification, and payment integrity efforts.
Conduct outcome analyses to determine impact and effectiveness of corporate program and payment integrity initiatives.
Lead the examination and interpretation of complex data relationships to support payment integrity, anomaly detection, and FWA investigations.
Lead monitoring and investigation of anomalies and emerging trends associated with potential Fraud, Waste, and Abuse activities across the enterprise.
Collaborate with the legal department, generating data and analyses to support legal proceedings.
Develop hypothesis tests and extrapolations on statistically valid samples to establish outlier behavior patterns and potential recoupment.
Lead development and communication of analytical strategies, project plans, methodologies, and investigative approaches for complex initiatives.
Design and develop advanced dashboards, visualizations, and reporting solutions that demonstrate model performance, program effectiveness, and program integrity outcomes.
Lead development of AI-enabled and business intelligence dashboards that support investigator workflows, fraud detection activities, operational monitoring, and executive decision-making.
Provide statistical validation and analysis of outcomes associated with clinical programs and interventions.
Provide technical leadership in integrating analytical solutions with enterprise systems, platforms, and operational workflows.
Present analytical findings, strategic recommendations, and program integrity insights to leadership and key stakeholders.
Lead preparation and deployment of production-ready analytical code, models, and automated decision-support solutions.
Research policy, billing guidelines, CMS direction and others to ideate new fraud, waste and abuse concepts to implement.
Perform any other job related duties as requested.

Education and Experience:

Bachelor's degree in Data Science, Mathematics, Statistics, Engineering, Computer Science, or a related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years data analysis and/or analytic programming required
One (1) year Experience with cloud services (such as Azure, AWS or Google Cloud Platform) and modern data stack (such as Databricks or Snowflake) preferred
Healthcare experience required
Experience supporting payment integrity, fraud detection, audit recovery, SIU, or program integrity initiatives preferred
Experience developing and applying deep learning, neural network, graph analytics, or graph neural network (GNN) solutions for fraud detection, anomaly identification, payment integrity, or healthcare analytics initiatives preferred

Competencies, Knowledge and Skills:

Advanced proficiency in SQL and at least one programming language such as Python or R
Familiarity with SAS is preferred
Proficient in designing and developing dashboards and reporting solutions using Power BI or similar business intelligence platforms
Ability to perform advanced statistical analyses and techniques including t-tests, ANOVAs, z-tests, statistical extrapolations, non-parametric significance testing, and sampling methodologies
Advanced knowledge of predictive modeling, machine learning, deep learning, neural networks, graph analytics, graph neural networks (GNNs), clustering, dimensionality reduction, anomaly detection, and natural language processing
Proficient in feature engineering techniques and exploratory data analysis
Ability to apply advanced analytical, artificial intelligence, and graph-based techniques to identify complex provider, member, claim, and organizational relationships associated with payment integrity, Fraud, Waste, and Abuse (FWA), anomaly detection, and recovery opportunities
Ability to analyze large quantities of information and identify patterns, irregularities, and deficiencies
Strong knowledge of healthcare coding, billing processes, reimbursement methodologies, claims adjudication and Program Integrity concepts.
Proficient with MS office (Excel, PowerPoint, Word, Access)
Demonstrated critical thinking, verbal communication, presentation and written communication skills
Ability to independently lead analytical initiatives and collaborate effectively across cross-functional teams
Familiarity with developing AI-enabled analytical solutions supporting fraud detection, anomaly identification, and payment integrity operations
Ability to mentor analysts and data scientists through analytical reviews, statistical guidance, and technical coaching

Licensure and Certification:

None

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time
Up to 15% (occasional) travel to attend meetings, trainings, and conferences may be required

Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business

Dice Id: RTX11f1ed
Position Id: dc36d4b872de1717512e6e7cf99584c5
Posted 13 hours ago

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

Data Scientist II

Remote or Dayton, Ohio

•

Today

Full-time

USD 83,000.00 - 132,800.00 per year

Senior Data Scientist

Remote

•

Today

Full-time

Data Specialist

Remote or Oklahoma

•

Today

Full-time

Sr. Healthcare Data Scientist (Medicare/Medicaid)

Remote

•

Today

Full-time

USD 97,968.00 - 132,250.00 per year