Data Scientist

• Analytics professional in payment integrity - stats and modeling data analytics team. Person will be responsible for delivering various fraud analytics statistical projects based on US healthcare data and other consulting assignment. These projects may involve model development, validation, governance, implementation and end to end delivery
• Lead and work closely with junior/senior statisticians to deliver Fraud, Waste, Abuse (FWA) statistical projects. Team builds models through advanced statistical techniques.
• Provide support to management in business development, client proposals and in building solid relationships with global analytics teams.
• Expert in data analytics with significant amount of project delivery skills in one or more of the following areas:
  • Model Building, Model Validation, Fraud detection Analytics, Risk Analytics, Multivariate Analysis

Primary Responsibilities:

• Collaborates across business units with stakeholders, providing thought leadership, and driving day-to-day implementation of our analytics strategy
• Demonstrable leadership ability, superior problem solving and people management skills.
• Evaluate statistical methods used to obtain the data to ensure validity, applicability, efficiency and accuracy. Interpret end-user technical requirements by specifying economic decision models, determining appropriate data sources, and performing detailed statistical analysis
• Create, analyze and maintain explanatory/predictive models of clinical behaviours on healthcare claims data. Work includes all phases of the modelling process: research design, data extraction and cleaning, model building and validation
• Research on the new fraud & abuse patterns and ideate new assignments/projects basis the secondary/data driven research
• Lead the advanced statistics domain for the team & develop/refine/improve predictive models using advance SAS, Python, Spark & machine learning techniques and mentors junior/senior analysts/statisticians to develop their modeling/statistical skills
• Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe, secure, and legal work environment; developing personal growth opportunities and accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards
• Co-ordinate with clinical/Coding SMEs for seeking the inputs to explore data extraction approach and road map the analysis milestones
• Develop and maintain working relationships with key customer stakeholders
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Masters degree in math or statistics from top universities (Tier I/II) with solid record of achievement and approximately 1+ years of relevant work experience
• 2+ years of work experience in the area(s) of statistical analysis, data modelling
• 1+ years of project management experience
• Experience in data analytics, predictive & statistical modeling, strategy, project management, team management and business development
• Experience comprising analytics service delivery, solution design and client management
• Expert focused on helping team improve modeling predictability, analytics driven strategy development, operational efficiency
• Knowledge of statistical tools and techniques, especially those relating to data mining & analysis. Should have ability to handle/work on large data sets
• Displays solid communication, interpersonal, and leadership ability across all levels coupled with effective problem solving, conceptual thinking, quantitative and analytical skills
• Demonstrated leadership ability and willingness to take initiative
• Excellent knowledge of SAS, Python/Spark, or any other statistical software to carry out analysis and drive conclusions
• Solid understanding and implementation experience on predictive modeling algorithms such as time series, neural networks, clustering, decision trees, heuristic models, with familiarity dealing with trade-off between model performance and business needs
• Solid project management skills, ability to influence cross-functionally in a rapidly evolving business environment while managing multiple/concurrent projects
• Must be able to communicate ideas effectively and concisely to all levels of Management, business partners, and to other external clients
• Ability to work independently and with a team

Preferred Qualifications:

• Experience/interest in Python, Tableau & Machine learning
• Experience/interest in building machine learning systems using big data
• Experience/interest in data visualization and presentation
• Knowledge of US/UK/Indian/Middle-East Healthcare system, Specially Fraud management Certifications - Technical SAS, Python, Spark; Healthcare domain - AHM