Sr. Healthcare Data Scientist (Medicare/Medicaid)

Position Overview

We are seeking a highly skilled Senior Healthcare Data Scientist (Medicare/Medicaid) to join our dynamic team based in Saudi Arabia. This role presents a unique opportunity to leverage cutting-edge data science, artificial intelligence, and advanced analytics to address some of the most pressing challenges in healthcare program integrity. As a key contributor, you will analyze vast datasets from Medicare and Medicaid claims to detect patterns associated with fraud, waste, and abuse, driving impactful solutions that enhance operational efficiency and program outcomes. This position is ideal for a forward-thinking data scientist eager to apply emerging technologies—such as generative AI, machine learning, and agent-based systems—to create innovative analytical frameworks that inform strategic decision-making and improve healthcare delivery.

Key Responsibilities

In this mission-driven role, you will:

• Analyze Healthcare Claims Data: Utilize statistical modeling, machine learning, and advanced analytical techniques to identify trends, anomalies, and potential instances of fraud, waste, or abuse within Medicare and Medicaid claims data.
• Develop AI-Powered Solutions: Design and implement generative AI-driven models, agent-based systems, and retrieval-augmented pipelines to strengthen fraud detection mechanisms, investigate complex patterns, and optimize business processes.
• Build Predictive and Anomaly Detection Models: Create and refine predictive models, anomaly detection algorithms, and other analytical tools to enhance program integrity, operational efficiency, and data-driven insights.
• Leverage Modern AI Technologies: Apply large-scale CMS data in conjunction with advanced AI methodologies, including large language models (LLMs), embeddings, vector databases, and retrieval-augmented generation (RAG) pipelines, to uncover actionable insights.
• Implement Robust Data Science Practices: Employ feature engineering, attribute selection, threshold optimization, model validation, and rigorous train/test methodologies to ensure the accuracy and reliability of analytical outputs.
• Communicate Insights Effectively: Develop clear, compelling data visualizations and presentations to convey complex findings and emerging trends to both technical and non-technical stakeholders, including senior leadership.
• Collaborate on Cross-Functional Initiatives: Contribute to additional data science, AI, and analytical projects as required, fostering a culture of innovation and continuous improvement.

Qualifications and Requirements

To excel in this role, you must possess the following:

• Educational Background: A Bachelor’s degree in a quantitative or technical field—such as Statistics, Computer Engineering, Applied Mathematics, Data Science, or a related discipline—or equivalent professional experience.
• Professional Experience: A minimum of five years of hands-on experience in data science, with at least two years dedicated to analyzing Medicare and/or Medicaid data. A deep understanding of healthcare claims and program data structures is essential.
• Technical Proficiency: Strong expertise in Python or R for data science and machine learning, with familiarity in libraries such as Pandas, NumPy, TensorFlow, Scikit-learn, Seaborn, ggplot, or Matplotlib. Proficiency in SQL and experience with modern data platforms (e.g., Databricks, Snowflake, Spark) are required.
• AI and Generative Technologies: Hands-on experience with generative AI frameworks and tools, including LangChain, LangGraph, Hugging Face Transformers, vector databases, agent frameworks, or LLM orchestration platforms.
• Analytical and Statistical Skills: A robust foundation in statistics, machine learning fundamentals, predictive modeling, feature engineering, and model evaluation principles.
• Collaboration and Communication: The ability to lead analytical projects independently while effectively collaborating with cross-functional teams. Exceptional storytelling and visualization skills to translate complex data insights into actionable recommendations for diverse audiences.
• Mindset and Approach: A proactive, curious, and self-directed attitude with a practical approach to problem-solving and the application of emerging technologies.

Why Join Us?

This role offers a competitive compensation package, with an estimated annual salary range of $97,968–$132,250, commensurate with experience, geographic location, and qualifications. Beyond financial rewards, you will be part of a mission-driven organization committed to improving healthcare integrity through innovation, collaboration, and data-driven decision-making. If you are passionate about leveraging AI and advanced analytics to make a tangible impact in healthcare, we invite you to apply and contribute to our vision of a more efficient and transparent healthcare system.