Lead Data Scientist- Fraud, Waste & Abuse
Company: Cohere Health
Location: Washington
Posted on: January 1, 2026
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Job Description:
We are looking for innovative and creative individuals who seize
opportunities to uncover hidden drivers, impacts, and key
influences to support our product, leadership and clinical teams by
applying optimization and statistical methods on a variety of data.
You will work closely with the clinical program and product teams
to support decision-making and will dig into a wide range of
strategic and clinical problems. As a growing organization, we have
built a team of talented and experienced people who are passionate
about helping providers and patients and this is a position that
offers the ability to make a substantial impact on the company with
rapid growth opportunities. You will be part of a growing data
science team within the technology organization. What you’ll do: •
Drive strategic data science initiatives that focus on preventing
and identifying healthcare fraud, waste and abuse. • Serve as a
subject matter expert on identifying and discovering claim and
authorization outliers and interpret and analyze data to
demonstrate key insights into trends and opportunities. •
Independently lead in-depth analyses of a variety of healthcare and
product data sources to investigate suspicious activities, and
prepares detailed reports of their findings • Stay up-to-date with
the latest industry trends, regulatory changes, and emerging fraud
schemes to enhance detection strategies. This role requires
maintaining meticulous methodology documentation and presenting
findings or recommendations to leadership group • Present
information using data visualization techniques and propose
solutions and strategies to business challenges What you’ll need: •
MSc or higher degree in a data science/ analytics, statistics,
mathematics, engineering related field • 7 years hands-on data
science experience at company where health outcome performance were
critical to the mission, preferably a healthcare insurance company
• Strong communication skills with the unique ability to translate
business needs from stakeholders into data science technical
requirements and translate data science results back to business
and clinical units. • Expert in conducting data mining in the
healthcare insurance industry and claims-related experience and
knowledge of coding, reimbursement, and claims processing policies
• Knowledge of the law and regulations as it relates to FWA
investigations and familiar with CMS medicare and medicaid policies
• Proficient in current modeling approaches, standard scientific
methods for intervention based analysis, trend identification,
causal inference, and pattern detection • Strong experience using a
variety of data mining/data analysis methods, utilizing a variety
of analytic tools, building and implementing models, creating
algorithms and running simulations • Experience with programming
languages (Python,PySpark, Scala and/or Spark SQL) • Experience
with graph database managing clinical concept is a big plus •
Experience with Amazon AWS cloud platform is a plus
Keywords: Cohere Health, Wilmington , Lead Data Scientist- Fraud, Waste & Abuse, IT / Software / Systems , Washington, Delaware
