Remote Data Sciences Advisor — AI-Powered Payment Integrity

Gainwell Technologies; Montgomery, Northern (AL, KY); Hybrid; USD 99,000 - 142,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Flexible vacation policy

Educational assistance

Job summary

Gainwell Technologies is seeking an Advisor Data Sciences to provide strategic and technical leadership in designing and scaling AI-enabled analytics that identify improper payments and improve claims accuracy across medical, dental, and pharmacy domains.

You will translate policies into scalable analytics and lead cross-functional teams to deliver high-impact payment integrity solutions for Gainwell clients.

Qualifications

• 7+ years of Healthcare Payment Integrity, Data Mining, or Advanced Analytics experience.

Responsibilities

• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives.
• Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments.
• Support and lead responses to client RFPs, contributing superior written content related to data mining, AI, and payment integrity capabilities.
• Translate complex healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules.
• Lead the incorporation of AI, machine learning, and advanced analytics techniques into payment integrity solutions.

Skills

Healthcare Payment Integrity

Data Mining

AI/ML Analytics

Regulatory Compliance

Job description

Gainwell Technologies is seeking an Advisor Data Sciences to provide strategic and technical leadership in designing and scaling AI-enabled analytics that identify improper payments and improve claims accuracy across medical, dental, and pharmacy domains.

You will translate policies into scalable analytics and lead cross-functional teams to deliver high-impact payment integrity solutions for Gainwell clients.