Data Scientist II – Fraud, Waste and Abuse

Centene Corporation

Data Scientist II developing scalable software solutions utilizing AI and ML for fraud detection at Centene. Manage multiple projects and assist with training Data Analysts in healthcare analytics.

Posted 4/23/2026full-timeRemote • Florida, Montana, New York, Washington • 🇺🇸 United StatesMid-LevelSenior💰 $87,700 - $157,800 per yearWebsite

Tech Stack

Tools & technologies

CloudPythonSparkSQL

About the role

Key responsibilities & impact

Develops scalable software solutions utilizing statistical, artificial intelligence (AI) and machine-learning (ML) modeling approaches in support of Fraud, Waste, & Abuse (FWA) detection
Identifies, accesses, compiles, and uses internal and external sources of relevant data
Performs research and testing to develop machine learning algorithms and predictive models
Conducts and reviews model training and evaluation
Integrates, tests, tunes, and monitors solutions
Design and develop data models to predict member outcomes or future impact of key member decisions
Design and construct analysis tools that extract, and analyze data and store analytical results in an appropriate format for business needs
Conduct exploratory data analysis from complex data sources and build key data sets to support Centene’s mission
Evaluate and design experiments to monitor key metrics and identify improvement opportunities
Develop mathematical and statistical models to distinguish relevant content or events and recognize patterns
Participate in presentations and communicate results of analysis and findings
Participate in the design of automated, operational analytics processes to achieve scale and durability of analysis processes
Validate and measure the outcomes of health management programs using SAS, R and other tools, to include provider data, claims data, membership data
Manage multiple projects as assigned
Assist with training Data Analysts.

Requirements

What you’ll need

Requires a Master’s degree in Statistics, Mathematics, Computer Science, Informatics, Econometrics, Engineering, Experimental Science with 3+ years of experience
Or a Bachelor’s degree and 5+ years of quantitative analysis experience in data science capabilities including data mining, predictive modeling, machine learning, statistical modeling, large scale data acquisition, transformation, and structured and unstructured data analysis
Experience in fraud/waste/abuse identification and investigation, provider billing, or clinical coding preferred
Knowledge of Home Health/Hospice and/or Behavioral Health billing, typical practice, and areas of potential FWA preferred
Knowledge of statistical analysis
Knowledge of building predictive models
SQL experience writing queries against complex relational databases
Experience with cloud computing environments, Spark, creating database schemas, continuous integration/continuous deployment, SQL, Python, REST APIs
Experience building ML/AI models using common methods within Python
Knowledge of JIRA and AGILE methodologies.

Benefits

Comp & perks

competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

statistical modelingmachine learningpredictive modelingdata miningdata analysisdata transformationSQLPythonAImathematical modeling

Soft Skills

communicationpresentationproject managementtraining

Certifications

Master’s degreeBachelor’s degree