Senior Data Scientist, Program Integrity & Fraud Prevention

CareSource; Dayton (OH); Hybrid; USD 94,000 - 165,000; Full time

Job summary

CareSource is seeking a Program Integrity Data Scientist III to lead the design, development, and deployment of advanced analytical solutions for payment accuracy, anomaly detection, and FWA prevention. You will mentor junior analysts and guide enterprise program integrity strategies while delivering dashboards and insights for executive decision-making.

The role emphasizes leadership in complex investigations, predictive modeling, and cross-functional collaboration with legal and operations

Qualifications

• Bachelor's degree or equivalent in a related field.
• 5+ years data analysis/analytic programming.
• 1+ year cloud services experience (Azure/AWS/GCP) and modern data stack preferred.
• Healthcare experience required.
• Experience with deep learning, graph analytics, or GNNs preferred.

Responsibilities

• Design, develop, and deploy advanced analytical solutions for payment integrity and FWA.
• Lead predictive modeling and anomaly detection initiatives.
• Mentor analysts and data scientists through reviews and coaching.
• Develop dashboards and reporting to demonstrate model performance and outcomes.
• Collaborate with legal to support proceedings with data and analyses.
• Present findings to leadership and stakeholders.

Skills

SQL

Python

R

Statistical analysis

Machine learning

Education

Bachelor's degree in Data Science, Mathematics, Statistics, Engineering, CS

Tools

Power BI

Databricks

Snowflake

Azure/AWS/GCP

SAS

Job description

CareSource is seeking a Program Integrity Data Scientist III to lead the design, development, and deployment of advanced analytical solutions for payment accuracy, anomaly detection, and FWA prevention. You will mentor junior analysts and guide enterprise program integrity strategies while delivering dashboards and insights for executive decision-making.

The role emphasizes leadership in complex investigations, predictive modeling, and cross-functional collaboration with legal and operations