Principal Data Scientist - Payment Integrity

8 - 10 years experience  •  Insurance

Salary depends on experience
Posted on 09/21/17
8 - 10 years experience
Salary depends on experience
Posted on 09/21/17

Primary Responsibilities:

  • Analytic thought leader with strong analytic, communication, and program management skills to lead management, development and integration of a portfolio of analytics that will form the intelligent engine of visually displayed insight to help health care professionals uncover fraud and other types of overpayments
  • Lead, develop, evaluate and present new techniques and methodologies to identify fraud and other forms of overpayments
  • Collaborate with other analytic teams to create analytic development projects that will be deployed through Optum end user tools for fraud and overpayment detection
  • Translate the results of the new methodologies into requirements for tool developers to include in end user applications
  • Create and provide sound statistical analyses and develop predictive models using structured and unstructured data, and frame business scenarios that are meaningful and which impact our critical business processes and / or decisions
  • Design sampling methodology, prepare data, including data cleaning, univariate analysis, missing value imputation, etc., identify appropriate analytic and statistical methodology, develop predictive models and document process and results
  • Communicate analytic results and predictive models to business partners and clients
  • Provide on - going tracking and monitoring of performance of analytic applications and recommend ongoing improvements to methods and algorithms that lead to findings, including new information


To be considered for this position, applicants need to meet the qualifications listed in this posting.

Required Qualifications:

  • Master's or Ph.D. degree in computer science, (bio) statistics, appliedstatistics, mathematics, machine learning or similar quantitative fields of study
  • 7+ years of experience of hands - on predictive modeling skills and strong analytic programming skills using either SAS, R and/or Python
  • 7+ years of experience manipulating large datasets and using databases using SQL and / or SAS
  • Experience with health care claims data with working knowledge and understanding of medical coding, including ICD, CPT, DRG, etc.
  • Self - motivated, capable to grasp analytical concepts and clearly understand how analytical solutions can help customers reduce their healthcare claim costs

Preferred Qualifications:

  • 3+ years program management skills
  • Experience with payment integrity modeling such as fraud detection, credit risk scoring, etc.
  • Experience with analysis and modeling using unstructured (text) data
  • H20experience
  • Strong communication and influencing skills


Not the right job?
Join Ladders to find it.
With a free Ladders account, you can find the best jobs for you and be found by over 20,0000 recruiters.