Healthcare Data Scientist

Centraprise is seeking a Healthcare Data Scientist for a fully remote contract role focused on analyzing healthcare claims and payer/provider data. The role involves developing predictive, anomaly detection, pattern recognition, and classification models using Databricks, Python, and SQL, while translating findings into actionable business insights and supporting operational AI/ML deployments.

Responsibilities:

• Deep understanding of healthcare payer/provider data, claims, DRG, ICD, CPT/HCC, risk adjustment, and coding patterns
• Strong experience building predictive, probabilistic, anomaly detection, and pattern recognition models
• Hands-on experience with Databricks, large-scale data processing, feature engineering, and model development
• Ability to identify trends, explain anomalies, convert analytical findings into actionable business recommendations
• Python, SQL, ML libraries, experimentation, model validation
• Experience in fraud, waste & abuse, payment integrity, claims auditing, utilization management, or coding intensity programs
• Knowledge of model operationalization, monitoring, governance, and performance measurement
• Ability to work closely with engineering, product, and healthcare domain experts
• 5+ years of experience as a Data Scientist with strong statistical and predictive modeling background
• Demonstrated experience working with healthcare claims or payer data
• Demonstrated ability to build anomaly detection, pattern recognition, or classification models
• Strong Databricks, Python, and SQL skills
• Ability to translate complex healthcare data into business insights and investigative "stories."
• Experience working in production environments where models support real operational decisions
• Experienced in working on proprietary algorithms and extremely sensitive intellectual property

Requirements:

• Deep understanding of healthcare payer/provider data, claims, DRG, ICD, CPT/HCC, risk adjustment, and coding patterns
• Strong experience building predictive, probabilistic, anomaly detection, and pattern recognition models
• Hands-on experience with Databricks, large-scale data processing, feature engineering, and model development
• Ability to identify trends, explain anomalies, convert analytical findings into actionable business recommendations
• Python, SQL, ML libraries, experimentation, model validation
• Experience in fraud, waste & abuse, payment integrity, claims auditing, utilization management, or coding intensity programs
• Knowledge of model operationalization, monitoring, governance, and performance measurement
• Ability to work closely with engineering, product, and healthcare domain experts
• 5+ years of experience as a Data Scientist with strong statistical and predictive modeling background
• Demonstrated experience working with healthcare claims or payer data
• Demonstrated ability to build anomaly detection, pattern recognition, or classification models
• Strong Databricks, Python, and SQL skills
• Ability to translate complex healthcare data into business insights and investigative "stories."
• Experience working in production environments where models support real operational decisions
• Experienced in working on proprietary algorithms and extremely sensitive intellectual property