Senior Manager, Machine Learning – Fraud, Waste and Abuse

Role Overview

• Manages the design and development of scalable software solutions utilizing statistical, artificial intelligence (AI), and machine-learning (ML) modeling approaches
• Performs and oversees research and testing to develop machine learning algorithms and predictive models
• Conducts and reviews model training and evaluation
• Integrates, tests, tunes, and monitors solutions
• Leads the design, development, and maintenance of predictive analytics, machine learning, and artificial intelligence solutions, making specific determinations about overall performance, reliability, and scalability
• Collaborate with multiple partner teams such as Business, Technology, Product Management, Legal, Compliance, Strategy and Business Management to develop use cases and to deploy solutions into production
• Communicates advanced ML/AI concepts to senior leadership to facilitate decision making
• Works cross functionally with product managers, data scientists, and engineers to understand, implement, refine, and design machine learning and other algorithms
• Maintains knowledge of new learning approaches, technology, and tools through continuous research to ensure currency of solutions
• Drives innovative ideas and act as one of the thought leaders in identifying and selecting use cases for applicability of machine learning, appropriate modeling techniques and technologies, and determines success criteria and implementation methodologies
• Manages the hiring and training of new and existing staff, conducts performance reviews, and provides leadership, technical guidance, and coaching
• Shares knowledge and develops staff capabilities to strengthen understanding of business issues and best practices
• Develops and communicates organizational objectives; inspires and motivates team members to achieve results
• Responsible for the establishment and maintenance of Agile Scrum ceremonies and methodologies on the team
• Performs other duties as assigned
• Complies with all policies and standards

Requirements

• Requires a Bachelor's degree and 6+ years of related experience, including prior management experience
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position
• 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
• Experience leading engineers through technical impediments and production support
• Experience with cloud computing environments, Spark, creating database schemas, continuous integration/continuous deployment, SQL, Python, REST APIs preferred
• Experience building ML/AI models using common methods within Python
• Knowledge of JIRA and Agile methodologies

Tech Stack

• Cloud
• Python
• Spark
• SQL

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules