Sr Data Scientist - Payment Integrity

Point32Health; Town of Canton (NY); Hybrid; USD 130,000 - 194,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Tuition program

Well-being benefits

Job summary

Point32Health seeks a Sr Data Scientist to deliver data-driven solutions from complex datasets. You will design experiments, build models, and translate findings into strategic recommendations that improve quality, consumer experience, and healthcare costs.

You will lead projects, mentor juniors, work with cloud platforms, and apply NLP/ML methods. A Master’s in data science or related field and 8–10 years with SAS/SQL are required.

Qualifications

• Master’s degree in data science, applied mathematics, computer science, statistics, epidemiology, or equivalent.
• 8–10 years as a Data Scientist or equivalent.
• 8–10 years with advanced ML, statistics, SAS/SQL and analytics tools.
• Experience with information management, data modeling, and audits.

Responsibilities

• Design, develop, and orchestrate experiments, models, and visualizations.
• Lead multiple projects; communicate results to non-technical audiences.
• Translate business needs into analytical questions.
• Apply ML, NLP, and statistical methods to drive insights and cost optimizations.
• Develop scalable data processes for model development and deployment.
• Mentor junior team members and uphold governance and ethics.

Skills

Python

ML algorithms

NLP

Cloud platforms

Data analysis

Agile

Communication

Project leadership

Strategic thinking

Lean thinking

Decision making

Education

Master’s degree in data science / related field

Tools

SAS

SQL

Azure

AWS

Google Cloud

Excel

PowerPoint

Job description

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Position will report into Payment Integrity’s Sr Manager Provider Audit. The Sr Data Scientist is responsible for delivering innovative, data-driven solutions through the analysis of complex, high-dimensional datasets. This role leverages exploratory data analysis, advanced statistical techniques, and AI-powered technologies to uncover patterns, identify opportunities, and generate actionable business insights. The Sr Data Scientist translates complex data into strategic recommendations, formulates critical business questions, and develops advanced analytical and AI-driven products that address key business challenges and drive measurable value.

Job Description

• Design, develop and orchestrate experiments, models, algorithms, and visualizations.
• Lead multiple and concurrent projects and manage project phases or smaller projects in their entirety. Communicate results and insights in a clear and concise manner to a non-technical audience.
• Identify, define, and translate business needs/problems into analytical questions.
• Apply advanced machine learning, natural language processing, statistical and computational methodologies to provide actionable insights and identify strategic opportunities that optimize quality, consumer experience, and healthcare costs.
• Lead and develop scalable, efficient, and automated processes for large scale data analyses and model development, validation, and implementation.
• Provide supervision and mentorship to junior team members and create/adhere to governance and ethical norms.
• Other duties and projects as assigned.

Certification and Licensure

• Relevant certifications are a plus.

Education

• Master’s degree in data science, Applied Mathematics, Computer science, Statistics, Epidemiology, or equivalent combination of experience and education.

Experience (minimum years required):

• 8 - 10 years of work experience in a Data Scientist or similar role, or equivalent combination of transferrable experience and education
• 8 - 10 years’ experience with advanced machine learning, statistics, and statistical packages (SAS, SQL) as well as Excel/PowerPoint skills (including visual graphics and analytics).
• Experience in information management best practices, including information lifecycle management, data modeling, and carrying out business audits and requirements gathering.

Skill Requirements

• Advanced knowledge and mastery in Python or other programming languages along with competence in using advanced statistical analysis, computational methodologies, and techniques.
• Mastery in developing supervised and unsupervised machine learning algorithms and data structures.
• Advanced knowledge in model evaluation, tuning, performance, operationalization, scalability of scientific techniques, and establishing decision strategies.
• Experience with cloud platforms like Azure, AWS, or Google Cloud.
• Proficiency in data analysis, cleaning, and preparation along with full understanding of data sources and limitations, warehousing system, and the impact of the data on business decisions.
• Knowledge of the agile development framework.
• Excellent written, visual, and oral communication skills.
• Lead projects and manage project phases along with ability to delegate and prioritize work independently and meet/exceed deadlines.
• Think strategically and broadly (end to end process), analyzing complex business problems.
• Act as a Lean thinker applying continuous improvement philosophies and approaches to identify and address inefficiencies in day-to-day work.
• Strong decision-making ability, teamwork, and collaborative skills. Proven track record of creating strong actionable insights that drive decision making and business process.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.

• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

• May be required to work additional hours beyond standard work schedule.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$129,565.60 -$194,348.40

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation andbenefits remains in the Company’s sole discretion and maybe modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.