Senior Data Scientist – Payment Accuracy

CVS Health; New York (NY); Hybrid; USD 111,000 - 222,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Data Scientist for the Provider & Network Analytics team in New York City. The role blends cutting-edge data science, machine learning, and AI to shape provider networks, engagement strategies, and member health journeys.

You will lead development of predictive models, leverage LLM-based solutions, and collaborate with cross-functional partners. The position is full-time, hybrid with one day onsite in NYC, and requires local candidates.

Qualifications

• Master's degree or equivalent work experience in Mathematics, Statistics, Computer Science, Business Analytics, Economics, Physics, Engineering, or related discipline.
• 5+ years of progressively complex, related experience.
• 2+ years of experience designing, building, and fine-tuning LLM-based solutions including RAG apps and autonomous AI agents.
• 2+ years of experience with GCP/Vertex AI or equivalent cloud ML platform.
• 3+ years of strong Python experience for data analysis, modeling, and building LLM/AI pipelines (pandas, scikit-learn).
• 3+ years of advanced SQL experience for querying and transforming large datasets.

Responsibilities

• Lead and participate in development, validation, and delivery of algorithms, models, and reporting tools.
• Develop and apply predictive models to evaluate scenarios and outcomes.
• Analyze structured and unstructured data using advanced statistical techniques.
• Collaborate with business partners to develop predictive models and performance metrics.
• Present analytics results and recommendations to stakeholders.
• Apply algorithms to investigate problems and detect patterns, recommending solutions.
• Use programming skills to explore and interpret large data volumes.

Skills

LLM-based solutions

RAG applications

Python

SQL

ML & predictive modeling

LLM frameworks

Pandas

Scikit-learn

Education

Master's degree or equivalent work experience

Tools

GCP Vertex AI

Python (pandas, scikit-learn)

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Please note: This is a hybrid role based out of our NYC office and requires one day per week onsite. We are seeking candidates who are local to the NYC area.

Position Summary

It’s a new day in healthcare. Combining CVS Health and Aetna was a groundbreaking moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans, and community pharmacists, we’re pioneering a bold new approach to total health. Looking for opportunities to use cutting-edge technologies to analyze petabytes of data? Interested in generating analytical insights that inform provider networks and engagement strategies that support members throughout their individualized health and wellness journeys? Aetna’s Provider & Network Analytics team delivers strategically impactful programs and tools that expand convenient access to high‑quality, affordable care for members across multiple channels and stages of life. As a Data Scientist on the Analytics & Behavior Change team, you’ll build industry‑leading analytics, data, and technology solutions that help reimagine healthcare. This position will play a critical role within a cross‑functional team, delivering solutions that:

• Inform network strategy and design
• Improve network performance and provider engagement
• Develop new provider offerings
• Enhance the consumer experience

You’ll be part of a fast‑paced, innovative, and collaborative team focused on solving complex problems and delivering meaningful insights. You’ll leverage innovations in data science, machine learning, deep learning, predictive modeling, and AI to derive meaning from data and deploy robust solutions through provider‑directed engagement channels.

Fundamental Responsibilities

• Lead and participate in the development, validation, and delivery of algorithms, statistical models, and reporting tools to solve complex analytical problems.
• Develop and apply algorithms and statistical predictive models to evaluate scenarios and potential future outcomes.
• Analyze structured and unstructured data using advanced statistical techniques and mathematical methods.
• Collaborate with business partners to understand problems and goals and develop predictive models, statistical analyses, data reports, and performance metrics.
• Develop and participate in presentations and consultations with internal and external stakeholders regarding analytics results and solutions.
• Apply strong knowledge of algorithms and predictive models to investigate problems, detect patterns, and recommend solutions.
• Use strong programming skills to explore, analyze, and interpret large volumes of data in various formats.

Required Qualifications

• 5+ years of progressively complex, related experience.
• 2+ years of experience designing, building, and fine‑tuning LLM‑based solutions, including RAG applications, enterprise search, conversational interfaces, and autonomous AI agents.
• 2+ years of experience with GCP and Vertex AI, or an equivalent cloud ML platform.
• 3+ years of strong Python experience for data analysis, modeling, and building LLM/AI pipelines, with libraries such as pandas, scikit‑learn, and common LLM frameworks.
• 3+ years of advanced SQL experience for querying, transforming, and validating large datasets, including complex joins, window functions, and query optimization.
• 2+ years of experience in classical ML, including classification, anomaly detection, feature engineering, and model validation, with the ability to combine ML with LLM‑based solutions.
• Strong knowledge of advanced analytics tools and programming languages used to analyze large datasets from multiple sources.
• Proficiency in mathematical analysis, machine learning, statistical analysis, and predictive modeling, with deeper specialization in one or more areas.

Preferred Qualifications

• Healthcare industry work experience is preferred.
• Strong ability to communicate technical concepts and implications to business partners.
• Demonstrated ability to anticipate and prevent problems and roadblocks.

Education

Master's degree or equivalent work experience in Mathematics, Statistics, Computer Science, Business Analytics, Economics, Physics, Engineering, or related discipline.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $111,240.00 - $222,480.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 01/18/2027.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.