Job Application for Lead Data Scientist- Fraud, Waste & Abuse at Cohere Health

Opportunity Overview:

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 healthcare fraud, waste and abuse including identification, investigation, validation, escalation and prevention
Performs proactive fraud, waste and abuse detection analysis derived from various monitoring based data sources
Serve as a subject matter expert on identifying and discovering claim and authorization outliers and interpret and analyze data to accurately assess and 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
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.
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
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

Pay & Perks:

💻 Fully remote opportunity with about 5% travel

🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program

📈 401K retirement plan with company match; flexible spending and health savings account

🏝️ Up to 184 hours (23 days) of PTO per year + company holidays

👶 Up to 14 weeks of paid parental leave

🐶 Pet insurance 

The salary range for this position $148,000 to $168,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

Interview Process*:

Connect with Talent Acquisition for a Preliminary Phone Screening
Meet your Hiring Manager!
Take Home Assessment
Case Study Presentation
Behavioral Interviews

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.

#LI-Remote

#BI-Remote

Create a Job Alert

Interested in building your career at Cohere Health? Get future opportunities sent straight to your email.

First Name

Last Name

Preferred First Name

Country

Phone

Resume/CV*

Accepted file types: pdf, doc, docx, txt, rtf

Cover Letter

Accepted file types: pdf, doc, docx, txt, rtf

Do you have 6+ years hands-on data science experience at company where health outcome performance were critical to the mission?

Select...

Do you have at least 3 years of experience in healthcare fraud waste and abuse investigation in big data/ big scale?

Select...

Do you have experience with AWS?

Select...

Are you advanced in Python?

Select...

Our base salary range for this role is [$148,000 – $168,000] annually. Do you acknowledge and agree that this range aligns with your compensation expectations?

Select...

How many years of experience in Fraud, waste and abuse healthcare data science do you have?

LinkedIn Profile

Website

Are you at least 18 years of age?

Select...

How did you hear about us?

Select...

Have you been previously employed at Cohere Health?

Select...

Do any of your immediate family members work at Cohere Health?

Select...

If you answered "yes" to the above, what is the name of the employee? If you answered "no", please type "N/A."

What is your legal mailing address?

In which of the following locations do you live?

Select...

Are you eligible and legally able to work in the United States?

Select...

Do you now, or will you in the future require immigration sponsorship for work authorization?

Select...

Are you currently, or have you ever been, excluded from, debarred or otherwise ineligible to participate in state or federally funded programs (“Government Programs”) or federal healthcare programs as defined in 42 USC § 1320a-7b(f) (“Federal Programs”)?

Select...

I understand that if I receive an offer of employment from Cohere Health that a background check will be performed on my behalf.

Select...

I HAVE READ THE CERTIFICATION ABOVE AND UNDERSTAND AND AGREE TO ITS TERMS. Please type your name and the date.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

As set forth in Cohere Health’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.

Gender

Select...

Are you Hispanic/Latino?

Select...

Race & Ethnicity Definitions

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Veteran Status

Select...

Voluntary Self-Identification of Disability

Form CC-305

Page 1 of 1

OMB Control Number 1250-0005

Expires 04/30/2026

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

Disability Status

Select...

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Lead Data Scientist- Fraud, Waste & Abuse

Apply for this job

Voluntary Self-Identification

Voluntary Self-Identification of Disability