Teams at CareSource

Analyzes healthcare encounter and claims data, resolves data and process issues, supports CMS and state regulatory submissions, monitors SLAs and performance metrics, and contributes to testing, reporting, automation, and process improvement. The role collaborates with IT, claims, enrollment, vendors, and regulatory stakeholders while ensuring compliant encounter reconciliation and accurate claims data.

Develop and deploy AI-enabled applications, web interfaces, and workflow integrations using low-code platforms and modern programming frameworks. Build Python and SQL automation, integrate generative AI and NLP capabilities, collaborate with data and business teams, and support testing, troubleshooting, Agile delivery, deployment, and incident management. Ensure solutions meet usability, accessibility, compliance, and performance standards.

Leads advanced data science and machine learning initiatives for healthcare payment integrity, including fraud, waste, and abuse detection, anomaly identification, predictive modeling, statistical analysis, dashboards, and recovery investigations. Provides technical leadership, mentors analysts, integrates production analytical solutions, collaborates with legal and business stakeholders, and presents findings to leadership. Requires healthcare expertise, advanced SQL and programming skills, and knowledge of claims, billing, reimbursement, and program integrity.