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We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: We are seeking a candidate with a keen sense of natural curiosity who will play a crucial role in enhancing claim and appeal operation and driving innovation through the application of data science. In this position, you will be responsible for leveraging advanced analytics including machine learning and large language model techniques to develop products that significantly improve the efficiency and accuracy of the claim and appeal operation process.
Job Responsibility:
Engaging various business stakeholders to translate complex business problems into technical requirements, define data science solutions fitting into the business process, and define the steps to build the solution
Leading and guiding junior data scientists, working along with product managers and data engineers to jointly build the solution and achieve business goal
Implementing models, developing tool and algorithms to augment processes related to Claims, Appeals and Grievances ecosystem
Leveraging analytics to build accurate and efficient solutions and enable automation
Identifying and sizing opportunities for analytics to improve efficiency and increase automation in claim and appeal adjudication
Developing, validating and executing algorithms and predictive models to investigate problems, detect patterns and recommend solutions
Exploring, examining and interpreting large volumes of data in various forms, both structured and unstructured
Utilizing advanced statistical techniques and mathematical analyses develops data structures and pipelines to organize, collect and standardize data that helps generate insights and addresses reporting needs
Using data visualization techniques to effectively communicate analytical results and support business decisions
Creating and evaluating the data needs of assigned projects and assures the integrity of the data
Exploring existing data and recommends additional sources of data for improvements
Documenting projects including business objectives, data gathering and processing, detailed set of results and analytical metrics
Building solutions that help with tracking of operational processes and policies and identify opportunities for improvements
Requirements:
7+ years of relevant Data Science experience
7+ years' experience programming in Python
7+ years' experience programming in SQL
5+ year experience working with Cloud Technology (GCP, AWS or Azure)
3+ year experience deploying models in production
3+ year of experience in working in an agile product development framework
Bachelor's degree or equivalent work experience in Business Analytics, Economics, Physics, Engineering, Mathematics, Statistics, Computer Science, or related discipline.
Nice to have:
Experience in Google Cloud/BigQuery
Strong problem solving experience with a history of making business impact