Cohere Health · 3 months ago
Lead Data Scientist- Fraud, Waste & Abuse
United States
Full-time
Remote
Senior Level, Lead/Staff
$148K/yr - $168K/yr
7+ years expCohere Health is a company focused on delivering AI-powered solutions to enhance healthcare processes and improve payer-provider collaboration. They are seeking a Lead Data Scientist to drive strategic initiatives related to healthcare fraud, waste, and abuse, utilizing data science techniques to analyze and prevent suspicious activities. The role involves close collaboration with clinical and product teams, requiring strong analytical and communication skills.
Consumer SoftwareHealth CareSaaSSoftware
Responsibilities
Drive strategic data science initiatives that focus on healthcare fraud, waste and abuse including identification, investigation, validation, escalation and prevention
Performs proactive fraud, waste and abuse detection analysis derived from various monitoring based data sources
Serve as a subject matter expert on identifying and discovering claim and authorization outliers and interpret and analyze data to accurately assess and demonstrate key insights into trends and opportunities
Independently lead in-depth analyses of a variety of healthcare and product data sources to investigate suspicious activities, and prepares detailed reports of their findings
Stay up-to-date with the latest industry trends, regulatory changes, and emerging fraud schemes to enhance detection strategies. This role requires maintaining meticulous methodology documentation and presenting findings or recommendations to leadership group
Strong communication skills with the unique ability to translate business needs from stakeholders into data science technical requirements and translate data science results back to business and clinical units
Present information using data visualization techniques and propose solutions and strategies to business challenges
Qualification
Required
MSc or higher degree in a data science/ analytics, statistics, mathematics, engineering related field
7+ years hands-on data science experience at company where health outcome performance were critical to the mission, preferably a healthcare insurance company
Expert in conducting data mining in the healthcare insurance industry and claims-related experience and knowledge of coding, reimbursement, and claims processing policies
Knowledge of the law and regulations as it relates to FWA investigations and familiar with CMS medicare and medicaid policies
Proficient in current modeling approaches, standard scientific methods for intervention based analysis, trend identification, causal inference, and pattern detection
Strong experience using a variety of data mining/data analysis methods, utilizing a variety of analytic tools, building and implementing models, creating algorithms and running simulations
Experience with programming languages (Python, PySpark, Scala and/or Spark SQL)
Experience with graph database managing clinical concept is a big plus
Benefits
Medical, dental, vision, life, disability insurance, and Employee Assistance Program
401K retirement plan with company match; flexible spending and health savings account
Up to 184 hours (23 days) of PTO per year + company holidays
Up to 14 weeks of paid parental leave
Pet insurance
Company
Cohere Health
Cohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery.
501-1000 employees
H1B Sponsorship
Cohere Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (27)
2024 (21)
2023 (18)
2022 (10)
2021 (7)
2020 (2)
Funding
Current Stage
Late StageTotal Funding
$186.1MKey Investors
Temasek HoldingsDeerfield ManagementPolaris Partners
2025-05-14Series C· $90M
2024-02-01Series C· $50M
2021-04-13Series B· $36.1M
Leadership Team
Siva Namasivayam
Chief Executive Officer
Robert Shepardson
Chief Financial Officer
Recent News
Company data provided by crunchbase