Lead development and deployment of an AI-driven Payment Integrity platform to detect claim anomalies and prevent inappropriate payments. Design and implement machine learning models, big data pipelines, and automation solutions to replace manual processes. Collaborate with cross-functional teams to ensure compliance, reduce financial leakage, and mitigate risks such as up-coding, modifier misuse, and policy violations.
Primary Responsibility:
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
Undergraduate degree or equivalent experience
Advanced degree in Data Science, Computer Science, or related field. Proven experience in AI/ML model development, big data technologies, and cloud platforms (Azure preferred)
Solid skills in Python, SQL, Spark, and Agile/Scrum methodologies. Expertise in healthcare claims, payment integrity, and compliance frameworks is highly desirable. Solid expertise in Python (basic and advanced concepts) for ML and data engineering workflows
Extensive experience with Big Data technologies including PySpark, Spark, and Databricks
Practical experience with Jupyter and cloud platforms such as Azure, AWS, or GCP
Handson experience in LLM text generation using APIs and agent frameworks
Experience building classification models using BERT or other Transformer architectures
Practical MLOps experience including model deployment, monitoring, and lifecycle management
Handson experience with LLMs, Transformer-based models, embeddings, and advanced NLP applications
Handson proficiency with Git, MLflow, cloud ML services, Kubernetes, and Terraform
Deep understanding of BERT, Transformers, and embeddings for NLP and GenAI solutions
Ability to design and implement RAG (Retrieval Augmented Generation) models
Solid knowledge of guardrailing techniques for safe and compliant LLM deployments
Expertise in developing, deploying, and optimizing endtoend ML and GenAI solutions
Solid command over Python-based data workflows and distributed Big Data systems
Proven ability to design scalable ML architectures, orchestrate pipelines, and ensure production reliability
Deep understanding of MLOps practices for model lifecycle management and enterprise-level deployment
Solid leadership skills with the ability to mentor teams, drive technical decisions, and influence stakeholders
Preferred Qualifications:
Experience with treebased models, regression/classification techniques, time series, clustering, and model optimization
Experience building and orchestrating pipelines using Databricks workflows
Team management experience including roadmap planning, prioritization, architecture design, and stakeholder management
Solid foundation in advanced statistics and scalable architecture for ML systems
Expertise in data cleaning, EDA, feature engineering, and scalable ETL/ML pipelines
Solid leadership qualities with effective decisionmaking, mentoring, and strategic communication
Job Classification
Industry: RetailFunctional Area / Department: Engineering - Software & QARole Category: DBA / Data warehousingRole: Database Architect / DesignerEmployement Type: Full time