Position SummaryWe are seeking a candidate with a keen sense of natural curiosity who will play a crucial role in enhancing claim and appeal operation and driving innovation through the application of data science. In this position, you will be responsible for leveraging advanced analytics including machine learning and large language model techniques to develop products that significantly improve the efficiency and accuracy of the claim and appeal operation process.
You will be working on
- Engaging various business stakeholders to translate complex business problems into technical requirements, define data science solutions fitting into the business process, and define the steps to build the solution
- Leading and guiding junior data scientists, working along with product managers and data engineers to jointly build the solution and achieve business goal
- Implementing models, developing tool and algorithms to augment processes related to Claims, Appeals and Grievances ecosystem
- Leveraging analytics to build accurate and efficient solutions and enable automation
- Identifying and sizing opportunities for analytics to improve efficiency and increase automation in claim and appeal adjudication
- Developing, validating and executing algorithms and predictive models to investigate problems, detect patterns and recommend solutions
- Exploring, examining and interpreting large volumes of data in various forms, both structured and unstructured
- Utilizing advanced statistical techniques and mathematical analyses develops data structures and pipelines to organize, collect and standardize data that helps generate insights and addresses reporting needs
- Using data visualization techniques to effectively communicate analytical results and support business decisions
- Creating and evaluating the data needs of assigned projects and assures the integrity of the data
- Exploring existing data and recommends additional sources of data for improvements
- Documenting projects including business objectives, data gathering and processing, detailed set of results and analytical metrics
- Building solutions that help with tracking of operational processes and policies and identify opportunities for improvements
Required Qualifications- 7+ years of relevant Data Science experience
- 7+ years' experience programming in Python
- 7+ years' experience programming in SQL
- 5+ year experience working with Cloud Technology (GCP, AWS or Azure)
- 3+ year experience deploying models in production
- 3+ year of experience in working in an agile product development framework
Preferred Qualifications- Experience in Google Cloud/BigQuery
- Strong problem solving experience with a history of making business impact
- Experience with Generative AI, LLM, and NLP
- Experience with healthcare industry and data
Education- Bachelor's degree or equivalent work experience in Business Analytics, Economics, Physics, Engineering, Mathematics, Statistics, Computer Science, or related discipline.
- Master's or PHD's degree preferred
Pay RangeThe typical pay range for this role is:
$130,295.00 - $260,590.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 06/24/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
