ConnectiveRx
Data Scientist - Claims Monitoring
ConnectiveRx, Pittsburgh, Pennsylvania, us, 15289
ConnectiveRx is a leading, technology-enabled healthcare services company. We work strategically with hundreds of biopharmaceutical manufacturers to help commercialize and maximize the benefits of specialty and branded medications. Our mission is to simplify how patients get on and stay on therapy. We fulfill our mission by providing our customers with innovative services such as patient and provider messaging, the design and operation of copay, vouchers and patient affordability programs, and hub services, all of which accelerate speed-to-therapy and help improve outcomes for manufacturers, healthcare providers and patients.ConnectiveRx was formed in 2015 by bringing together the industry-leading business of PSKW, PDR/LDM, Careform (2017) and The Macaluso Group (2018) to advance our technology-driven expertise in providing state-of-the-art commercialization solutions. To learn more about our company, visit ConnectiveRx.com.Job Description
A Data Scientist specializing in pharmacy claims monitoring plays a pivotal role in leveraging advanced analytics and machine learning techniques to extract valuable insights from vast datasets related to pharmacy claims. This professional is adept at developing predictive models, analyzing trends, and identifying patterns that contribute to optimizing pharmaceutical processes and ensuring compliance. By utilizing statistical methodologies and data visualization tools, the data scientist interprets complex data sets to generate actionable recommendations for enhancing the efficiency of pharmacy claims processing, detecting potential fraud, and improving patient outcomes. Additionally, the role involves collaborating with cross-functional teams, including pharmacists, healthcare providers, and IT specialists, to design and implement data-driven solutions that align with regulatory standards and industry best practices. The data scientist in this position contributes to the continuous improvement of pharmacy operations, ultimately supporting informed decision-making and delivering higher quality healthcare services.What You Will Do
Conduct advanced data analysis using various machine learning techniques to identify suspicious activities (trends, anomalies, segments, and clusters) and explore opportunities for process optimization and risk mitigation.Build and manage machine learning models from inception to implementation, ensuring their effectiveness and alignment with business goals.Oversee the lifecycle of machine learning models, including auditing, testing, and benchmarking, utilizing performance metrics for continuous improvement.Work closely with the Risk Operations team, integrating their insights for a comprehensive approach to risk management.Regularly update and refine monitoring systems to ensure accuracy and effectiveness in real-time suspicious activity detection.Develop and maintain sophisticated dashboards, alerts, and reports to monitor trends and evaluate the effectiveness of risk mitigation strategies, offering actionable insights for ongoing risk management.Coordinate with the Technology team for the deployment and monitoring of machine learning detection models.Work with other data scientists and stakeholders in developing strategies for client protection, focusing on real-time data availability and comprehensive customer views for intelligent decision-making.Utilize a broad range of technologies including Python, AWS, Tableau, Power BI, Looker, etc., to uncover insights in large volumes of data.Demonstrate strong communication skills to translate complex data science concepts into clear business objectives.Actively seek out a broad understanding of the ConnectiveRx services, data sets and value proposition as well as work effectively to enable other capabilities in Analytics, including business intelligence and Customer Success to leverage data science.What We Will Need From You
Healthcare or pharmaceutical industry experience preferred.Experience in building BI dashboards in Tableau or Looker required.Experience with AWS services: Redshift, Athena, Glue, Comprehend, and Sagemaker.Demonstrated skills in selecting the right statistical tools given a data analysis problem.Master's degree in a quantitative discipline (e.g., Statistics, Operations Research, Bioinformatics, Economics, Computational Biology, Computer Science, Mathematics) or equivalent practical experience.5+ years analytics experience.Strong analytics skills, ability to interpret data and articulate the ‘story’ to the client.Strong presentation skills, ability to articulate complex analytics to a non-technical audience.Continuously learning and developing technical and presentation skillset.Willingness to travel to CRx locations or clients as requested.Why work with us?
Excellent company culture, fun events, and volunteer opportunities.Competitive benefits (medical, dental, vision & more).401k package with dollar-for-dollar match-up.Generous PTO and paid holidays days offered.Opportunities to grow professionally and personally.Team-oriented atmosphere.Equal Opportunity Employer: This employer (hereafter the Company) is an equal opportunity employer and does not discriminate in recruitment, hiring, training, promotion, or other employment policies on the basis of age, race, sex, color, religion, national origin, disability, veteran status, genetic information, or any other basis that is prohibited by federal, state, or local law. No question in this application is intended to secure information to be used for such discrimination. In addition, the Company makes reasonable accommodation to the needs of disabled applicants and employees, so long as this does not create an undue hardship on the Company or threaten the health or safety of others at work. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.Apply Now
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A Data Scientist specializing in pharmacy claims monitoring plays a pivotal role in leveraging advanced analytics and machine learning techniques to extract valuable insights from vast datasets related to pharmacy claims. This professional is adept at developing predictive models, analyzing trends, and identifying patterns that contribute to optimizing pharmaceutical processes and ensuring compliance. By utilizing statistical methodologies and data visualization tools, the data scientist interprets complex data sets to generate actionable recommendations for enhancing the efficiency of pharmacy claims processing, detecting potential fraud, and improving patient outcomes. Additionally, the role involves collaborating with cross-functional teams, including pharmacists, healthcare providers, and IT specialists, to design and implement data-driven solutions that align with regulatory standards and industry best practices. The data scientist in this position contributes to the continuous improvement of pharmacy operations, ultimately supporting informed decision-making and delivering higher quality healthcare services.What You Will Do
Conduct advanced data analysis using various machine learning techniques to identify suspicious activities (trends, anomalies, segments, and clusters) and explore opportunities for process optimization and risk mitigation.Build and manage machine learning models from inception to implementation, ensuring their effectiveness and alignment with business goals.Oversee the lifecycle of machine learning models, including auditing, testing, and benchmarking, utilizing performance metrics for continuous improvement.Work closely with the Risk Operations team, integrating their insights for a comprehensive approach to risk management.Regularly update and refine monitoring systems to ensure accuracy and effectiveness in real-time suspicious activity detection.Develop and maintain sophisticated dashboards, alerts, and reports to monitor trends and evaluate the effectiveness of risk mitigation strategies, offering actionable insights for ongoing risk management.Coordinate with the Technology team for the deployment and monitoring of machine learning detection models.Work with other data scientists and stakeholders in developing strategies for client protection, focusing on real-time data availability and comprehensive customer views for intelligent decision-making.Utilize a broad range of technologies including Python, AWS, Tableau, Power BI, Looker, etc., to uncover insights in large volumes of data.Demonstrate strong communication skills to translate complex data science concepts into clear business objectives.Actively seek out a broad understanding of the ConnectiveRx services, data sets and value proposition as well as work effectively to enable other capabilities in Analytics, including business intelligence and Customer Success to leverage data science.What We Will Need From You
Healthcare or pharmaceutical industry experience preferred.Experience in building BI dashboards in Tableau or Looker required.Experience with AWS services: Redshift, Athena, Glue, Comprehend, and Sagemaker.Demonstrated skills in selecting the right statistical tools given a data analysis problem.Master's degree in a quantitative discipline (e.g., Statistics, Operations Research, Bioinformatics, Economics, Computational Biology, Computer Science, Mathematics) or equivalent practical experience.5+ years analytics experience.Strong analytics skills, ability to interpret data and articulate the ‘story’ to the client.Strong presentation skills, ability to articulate complex analytics to a non-technical audience.Continuously learning and developing technical and presentation skillset.Willingness to travel to CRx locations or clients as requested.Why work with us?
Excellent company culture, fun events, and volunteer opportunities.Competitive benefits (medical, dental, vision & more).401k package with dollar-for-dollar match-up.Generous PTO and paid holidays days offered.Opportunities to grow professionally and personally.Team-oriented atmosphere.Equal Opportunity Employer: This employer (hereafter the Company) is an equal opportunity employer and does not discriminate in recruitment, hiring, training, promotion, or other employment policies on the basis of age, race, sex, color, religion, national origin, disability, veteran status, genetic information, or any other basis that is prohibited by federal, state, or local law. No question in this application is intended to secure information to be used for such discrimination. In addition, the Company makes reasonable accommodation to the needs of disabled applicants and employees, so long as this does not create an undue hardship on the Company or threaten the health or safety of others at work. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.Apply Now
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