Lead Data Scientist, Cohere Health
Fraud, Waste & Abuse
$148-168k
+ Bonus
More information about location
Simplifying healthcare for patients and their doctors
Be an early applicant
Simplifying healthcare for patients and their doctors
501-1000 employees
Be an early applicant
$148-168k
+ Bonus
More information about location
501-1000 employees
Company mission
To make the healthcare journey better for everyone.
Role
Who you are
- 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
- 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
What the job involves
- 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
- Drive strategic data science initiatives that focus on healthcare fraud, waste and abuse including identification, investigation, validation, escalation and prevention
- Performs proactive fraud, waste and abuse detection analysis derived from various monitoring based data sources
- Serve as a subject matter expert on identifying and discovering claim and authorization outliers and interpret and analyze data to accurately assess and 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
- 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
- Present information using data visualization techniques and propose solutions and strategies to business challenges
Application process
- Connect with Talent Acquisition for a Preliminary Phone Screening
- Meet your Hiring Manager!
- Take Home Assessment
- Case Study Presentation
- Behavioral Interviews
- Subject to change
Our take
Every year, billions of dollars are wasted in healthcare through overtreatment, failure of care coordination, and administrative complexity. Cohere Health blames this on the prior authorization process, a time-consuming manual system that the company aims to modernize with its CohereNext platform.
Cohere Health's platform automates the authorization process to help avoid care delays and friction between parties, while also providing analytics to identify the most suitable physicians and care paths for the patient. While there are a host of other solutions that also automate these tasks, Cohere claims to stand out by improving the whole patient journey, rather than just automating an administrative transaction.
Through partnerships with organizations like Humana and the American Academy of Orthopaedic Surgeons, Cohere Health serves millions of members and thousands of physicians. By securing impressive funding, the company has been able to scale beyond its pandemic-era initial success, to be recognized as a top player in the space. Its latest release is "Cohere Unify", an end-to-end solution for administrative efficiency that is driven by advanced analytics and AI/ML algorithms.
Steph
Company Specialist at Welcome to the Jungle
Insights
35% employee growth in 12 months
Company
Funding (last 2 of 5 rounds)
May 2025
$90m
SERIES C
Feb 2024
$50m
LATE VC
Total funding: $196m
Company benefits
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life & Disability Insurance
- Flexible Time Off & Holidays
- 401(K) Retirement Plan with Employer Match Program
- Wellness Coach App
- Parental Leave
- Learning & Development Opportunities
Company HQ
West End, Boston, MA
Leadership
Siva Namasivayam
(CEO)Worked as a Software Engineer for Intel before working at Fidelity and spending 4 years as a Gartner Director of Consulting. They were CEO of SCIO Health Analytics before co-founding Cohere Health.
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