Staff Data Scientist | Fraud / Billing

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Staff Data Scientist | Fraud / Billing

We are seeking a Staff Data Scientist. This role will be responsible for leading the build and deployment of classical ML and GenAI systems that generate and validate billing error, audit, and fraud concepts in healthcare payments. You will partner with SMEs and cross-functional stakeholders to deliver production-grade capabilities with clear customer and financial impact.

What you will do:

• Build and ship classical ML and GenAI pipelines that surface, rank, and explain candidate billing error, audit, and fraud concepts across large-scale healthcare claims data

• Advance state-of-the-art research in anomaly detection, information retrieval, and weak supervision, turning research into robust production systems

• Accelerate concept generation and concept validation with SMEs by designing human-in-the-loop workflows that enable high-throughput review with strong precision, recall, and traceability

• Own end-to-end delivery from problem framing and data strategy to model development, evaluation, deployment, and monitoring, with a focus on reliability and customer outcomes

• Partner cross-functionally with Product, Data Engineering, Operations, SMEs, and business leaders to prioritize work, unblock execution, and unlock material financial value

• Help scale the team and platform as Machinify grows aggressively toward resale and IPO readiness
  

What you bring:

• Degree in Computer Science, Engineering, or a related field

• 10+ years of data science experience, with at least 5 years in a leadership role, including a leadership role at a start-up. Proven track record of managing data teams and delivering complex, high-impact products from concept to deployment

• Strong knowledge of data privacy regulations and best practices in data security

• Exceptional team management abilities, with experience in building and leading high-performing teams

• Ability to think strategically and execute methodically

• Ability to drive change and inspire a distributed team

• Strong problem-solving skills and a data-driven mindset

• Ability to communicate effectively, collaborating with diverse groups to solve complex problems

• You embrace challenges with optimism and a balanced, and bring a business-oriented approach to product development

• You prioritize customer impact, ensuring your work significantly advances our product value
  

What we offer:

• A flexible and trusting environment where you'll feel empowered to do your best work.

• Work from anywhere in the US! Our team is distributed and most of us work from home.

• Hardworking and supportive colleagues, and a leadership team that understands the importance of recruiting and retaining top talent.

• Incredible medical, vision, and dental benefits for employees & their families.

• Competitive salary and equity, 401(k) sponsorship.

Equal Employment Opportunity at Machinify

Machinify is committed to hiring talented and qualified individuals with diverse backgrounds for all of its positions. Machinify believes that the gathering and celebration of unique backgrounds, qualities, and cultures enriches the workplace. 

See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/