Lead Data Scientist- Fraud, Waste & Abuse

Company: Cohere Health
Location: Washington
Posted on: January 1, 2026

Job Description:

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. What you’ll do: • Drive strategic data science initiatives that focus on preventing and identifying healthcare fraud, waste and abuse. • Serve as a subject matter expert on identifying and discovering claim and authorization outliers and interpret and analyze data to 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 • Present information using data visualization techniques and propose solutions and strategies to business challenges What you’ll need: • 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 • 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. • 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 • Experience with Amazon AWS cloud platform is a plus

Keywords: Cohere Health, Washington DC , Lead Data Scientist- Fraud, Waste & Abuse, IT / Software / Systems , Washington, DC