Senior Data Scientist – Payment Accuracy

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

It’s a new day in healthcare.

Combining CVS Health and Aetna was a groundbreaking moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans, and community pharmacists, we’re pioneering a bold new approach to total health.

Looking for opportunities to use cutting-edge technologies to analyze petabytes of data? Interested in generating analytical insights that inform provider networks and engagement strategies that support members throughout their individualized health and wellness journeys?

Aetna’s Provider & Network Analytics team delivers strategically impactful programs and tools that expand convenient access to high-quality, affordable care for members across multiple channels and stages of life.

As a Data Scientist on the Analytics & Behavior Change team, you’ll build industry-leading analytics, data, and technology solutions that help reimagine healthcare. This position will play a critical role within a cross-functional team, delivering solutions that:

• Inform network strategy and design
• Improve network performance and provider engagement
• Develop new provider offerings
• Enhance the consumer experience

You’ll be part of a fast-paced, innovative, and collaborative team focused on solving complex problems and delivering meaningful insights. You’ll leverage innovations in data science, machine learning, deep learning, predictive modeling, and AI to derive meaning from data and deploy robust solutions through provider-directed engagement channels.

• →Lead and participate in the development, validation, and delivery of algorithms, statistical models, and reporting tools to solve complex analytical problems.
• →Develop and apply algorithms and statistical predictive models to evaluate scenarios and potential future outcomes.
• →Analyze structured and unstructured data using advanced statistical techniques and mathematical methods.
• →Collaborate with business partners to understand problems and goals and develop predictive models, statistical analyses, data reports, and performance metrics.
• →Develop and participate in presentations and consultations with internal and external stakeholders regarding analytics results and solutions.
• →Apply strong knowledge of algorithms and predictive models to investigate problems, detect patterns, and recommend solutions.
• →Use strong programming skills to explore, analyze, and interpret large volumes of data in various formats.

• 5+ years of progressively complex, related experience.
• 2+ years of experience designing, building, and fine-tuning LLM-based solutions, including RAG applications, enterprise search, conversational interfaces, and autonomous AI agents.
• 2+ years of experience with GCP and Vertex AI, or an equivalent cloud ML platform.
• 3+ years of strong Python experience for data analysis, modeling, and building LLM/AI pipelines, with libraries such as pandas, scikit-learn, and common LLM frameworks.
• 3+ years of advanced SQL experience for querying, transforming, and validating large datasets, including complex joins, window functions, and query optimization.
• 2+ years of experience in classical ML, including classification, anomaly detection, feature engineering, and model validation, with the ability to combine ML with LLM-based solutions.
• Strong knowledge of advanced analytics tools and programming languages used to analyze large datasets from multiple sources.
• Proficiency in mathematical analysis, machine learning, statistical analysis, and predictive modeling, with deeper specialization in one or more areas.

• Healthcare industry work experience is preferred
• Strong ability to communicate technical concepts and implications to business partners.
• Demonstrated ability to anticipate and prevent problems and roadblocks.

• Master's degree or equivalent work experience in Mathematics, Statistics, Computer Science, Business Analytics, Economics, Physics, Engineering, or related discipline.

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.