Senior Healthcare Data Scientist - Medicare/Medicaid Fraud Detection & AI Solutions

Jobgether • Belgium

Remote

This Job is No Longer Active This position is no longer accepting applications

AI Summary

Lead advanced data science and AI initiatives to combat fraud, waste, and abuse in Medicare/Medicaid claims. Analyze large-scale healthcare data using statistical modeling, machine learning, and generative AI to drive program integrity. Translate complex technical insights into actionable recommendations for diverse stakeholders.

Key Highlights

Apply advanced data science, AI, and generative models to healthcare fraud detection

Work with Medicare/Medicaid claims data to uncover patterns and anomalies

Collaborate on mission-driven initiatives with modern AI tools and frameworks

Key Responsibilities

Analyze Medicare and Medicaid claims data using statistical methods, machine learning, and advanced analytical techniques to identify trends, anomalies, and potential fraud, waste, and abuse

Develop generative AI-powered solutions and agent-based systems to strengthen fraud detection, investigate complex patterns, and improve business processes

Build predictive, anomaly detection, and other analytical models that improve program integrity, operational efficiency, and actionable insights

Identify opportunities to apply large-scale CMS data with modern AI and machine learning approaches, including LLMs, embeddings, vector databases, and retrieval-augmented generation pipelines

Apply sound data science practices including feature engineering, attribute selection, threshold setting, model validation, and train/test methodologies

Create clear and effective data visualizations that communicate complex findings and emerging trends

Present analytical results and recommendations to both technical and non-technical stakeholders, including senior leadership

Contribute to additional analytical, data science, and AI initiatives as required

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Technical Skills Required

Python Machine Learning Data Science

Benefits & Perks

Fully remote work environment

Estimated annual salary range of $97,968–$132,250

Multiple medical, dental, and vision insurance options

401(k) retirement savings plan with company matching

Paid vacation, sick, personal, and holiday time

Short- and long-term disability coverage, life insurance, and critical illness benefits

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Nice to Have

Proficiency in R for data science and machine learning

Experience with SQL and modern data platforms such as Databricks, Snowflake, and Spark

Hands-on experience with generative AI technologies and frameworks, such as LangChain, LangGraph, Hugging Face Transformers, vector databases, agent frameworks, or LLM orchestration tools

Job Description

This role offers the opportunity to apply advanced data science and AI to some of the most complex challenges in healthcare program integrity.You will analyze large-scale Medicare and Medicaid claims data to uncover patterns associated with fraud, waste, and abuse.The position combines statistical modeling, machine learning, generative AI, and agent-based technologies to create innovative analytical solutions.You will work with modern tools including LLMs, embeddings, vector databases, and retrieval-augmented pipelines.Your insights will support better decision-making, operational efficiency, and stronger outcomes across healthcare programs.

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