Lead, Ideation Affordability Decision Scientist
Core
Strategic analytics and ideation leader driving Payment Integrity initiatives, specifically focusing on Fraud, Waste & Error (FWE) and Special Investigations Unit (SIU) programs to improve affordability outcomes.
Role type
Senior IC Decision Scientist (Leadership)
Builds
Enterprise value across Payment Integrity programs via ideation pipelines and analytical frameworks
Domain
Healthcare + Payment Integrity/Fraud Detection
Deliverable
production ML models | dashboards & analysis | client delivery
Required skills
Healthcare analytics, Payment Integrity, FWE, SIU, claims platforms (ACAS, QNXT, HRP), SAS, SQL, Python, R, advanced data analysis, business case development, healthcare reimbursement methodologies
Preferred skills
Accredited Healthcare Fraud Investigator (AHFI) certification, Certified Professional Coder (CPC), independent research, stakeholder influence
Technologies
SAS, SQL, Python, R, ACAS, QNXT, HRP
Responsibilities
Provide leadership and mentorship to Decision Scientists; manage ideation pipelines from intake to implementation; partner with SIU and Clinical Policy teams to identify affordability opportunities; analyze complex healthcare claims data to identify patterns and anomalies; develop integrated analytic datasets and predictive analyses; present executive-ready recommendations to senior leadership; evaluate emerging AI-enabled solutions for Payment Integrity.
Seniority
Senior, hands-on IC with leadership responsibilities
