Senior Data Scientist – Machine Learning

This is a fully remote position, open to applicants in United States.

📋 Description

• Design, train, and validate supervised machine learning models to assess providers and billing patterns for risks related to fraud, waste, and abuse.

• Utilize investigative case-level data, payer feedback, and public exclusion and enforcement data for labeling purposes.

• Execute entity resolution to link enforcement records with providers in claims.

• Create validations for delayed labels, limited coverage, extreme class imbalances, and rapidly evolving schemes.

• Engineer features against billions of claims stored within the data warehouse using Python and SQL.

• Provide ranked model outputs accompanied by human-readable rationales and claim-level evidence.

• Modify scores for case mix and specialty while optimizing precision at the top of review queues.

• Implement models in production, encompassing scheduling, versioning, and drift monitoring.

• Establish modeling and deployment protocols for the Data Science team.

• Collaborate with FWA Subject Matter Experts to differentiate genuine anomalies from patterns explained by policy or edits.

• Convey methodology and limitations to HFPP partners and stakeholders.

• Assist investigators and clients in adopting and acting upon analytic outputs.

⛳️ Requirements

• Master’s degree in a quantitative field, or a Bachelor’s degree with equivalent practical experience.

• Over 5 years of experience in building, validating, and delivering supervised machine learning models based on real-world data.

• Familiarity with incomplete, delayed, or biased labels.

• Proven experience in deploying and maintaining production models, including scheduling, versioning, and drift monitoring.

• Proficiency in Python and SQL.

• Expertise in feature engineering within large-scale data warehouses.

• At least 2 years of experience working with healthcare claims data, including Medicare, Medicaid, or commercial claims.

• Knowledge of coding systems such as ICD-10, CPT, HCPCS, and DRG.

• Experience in designing validation processes for imbalanced and temporally shifting problems.

• Understanding of out-of-time evaluation, leakage detection, calibration, and precision-focused ranked-output metrics.

• Capability to articulate model output to non-technical investigators.

• Proficiency in defending methodology to technical audiences and presenting analytic results to clients and stakeholders.

• Must be able to obtain and maintain Public Trust.

• No work visa sponsorship is provided.

• Candidates must reside in the United States.

🏝️ Benefits

• Options for medical plans, including those with Health Savings Accounts.

• Choices for dental plans.

• Vision plan availability.

• 401(k) plan featuring pre-tax and post-tax contributions with company matching.

• Full-flex work weeks whenever feasible.

• Vacation, sick, and personal time off.

• Paid holidays.

• Paid parental leave.

• Military leave support.

• Bereavement leave provisions.

• Jury duty leave accommodations.

• Typically, 15 days of paid leave are provided each calendar year.

• An additional 10 paid holidays each year.

• Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• Remote work opportunities.