Lead Data Scientist

Position Summary

We are seeking a candidate with a keen sense of natural curiosity who will play a crucial role in enhancing claim and appeal operations and driving innovation through the application of data science. In this position, you will be responsible for leveraging advanced analytics including machine learning and large language model techniques to develop products that significantly improve the efficiency and accuracy of the claim and appeal operation process.

You will engage various business stakeholders to translate complex business problems into technical requirements, define data science solutions fitting into the business process, and define the steps to build the solution. You will lead and guide junior data scientists, work alongside product managers and data engineers to jointly build the solution and achieve business goals, implement models, develop tools and algorithms to augment processes related to Claims, Appeals, and Grievances ecosystem, and leverage analytics to build accurate and efficient solutions that enable automation.

• Engage various business stakeholders to translate complex business problems into technical requirements.
• Define data science solutions fitting into the business process and define the steps to build the solution.
• Lead and guide junior data scientists, working alongside product managers and data engineers to jointly build the solution and achieve business goals.
• Implement models, develop tools and algorithms to augment processes related to Claims, Appeals, and Grievances ecosystem.
• Leverage analytics to build accurate and efficient solutions and enable automation.
• Identify and size opportunities for analytics to improve efficiency and increase automation in claim and appeal adjudication.
• Develop, validate, and execute algorithms and predictive models to investigate problems, detect patterns, and recommend solutions.
• Explore, examine, and interpret large volumes of data in various forms, both structured and unstructured.
• Utilize advanced statistical techniques and mathematical analyses to develop data structures and pipelines that organize, collect and standardize data to generate insights and address reporting needs.
• Use data visualization techniques to effectively communicate analytical results and support business decisions.
• Create and evaluate the data needs of assigned projects and assure the integrity of the data.
• Explore existing data and recommend additional sources of data for improvements.
• Document projects, including business objectives, data gathering and processing, detailed set of results and analytical metrics.
• Build solutions that help with tracking of operational processes and policies and identify opportunities for improvements.

• 7+ years of relevant Data Science experience.
• 7+ years of experience programming in Python.
• 7+ years of experience programming in SQL.
• 5+ years of experience working with Cloud Technology (GCP, AWS or Azure).
• 3+ years of experience deploying models in production.
• 3+ years of experience working in an agile product development framework.
• Education:
  
  Bachelor's degree or equivalent work experience in Business Analytics, Economics, Physics, Engineering, Mathematics, Statistics, Computer Science, or related discipline.

• Experience in Google Cloud/Big Query.
• Strong problem solving experience with a history of making business impact.
• Experience with Generative AI, LLM, and NLP.
• Experience with healthcare industry and data.
• Master's or PhD’s degree.

The typical pay range for this role is: $ - $. 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.

This position also includes an award target in the company’s equity award program.

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources based on eligibility.

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