Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Domain: Healthcare | Claims Payment Integrity (PI) - M&R, C&S, E&I
Tech Focus: Databricks Lakehouse (PySpark, MLflow, Delta Lake)
Role Summary
Owns end to end data science strategy and delivery for prioritized PI use cases. Leads problem framing, modeling strategy, and measurable business impact. Mentors Sr/DS team members, partners with AI/ML Engineering for productionization, and sets standards for quality, governance, and explainability in a Databricks environment.
Primary Responsibilities:
- Strategy & Roadmap: Define modeling approach, feature strategy, and impact measurement for PI initiatives (leakage, adjudication accuracy, duplicate, pricing/contract issues)
- Advanced Modeling: Build and review robust models (classification, anomaly detection, cost forecasting, uplift/propensity, time series); drive feature store adoption and reusable assets
- Explainability & Risk: Embed SHAP/feature attribution, bias checks, stability/monitoring, and champion challenger frameworks
- Business Outcomes: Translate insights into recovery dollars, prevented leakage, and operational KPIs; lead A/B and quasi experimental tests for ROI
- Technical Leadership: Code reviews, standards, reproducibility (MLflow), and performance optimization at Spark scale
- Collaboration: Work with PI SMEs, Actuarial, Finance, Audit/Recovery, and AI/ML Engineering to convert prototypes to production jobs
- People Leadership: Mentor Sr DS/DS; guide story slicing, estimation, and backlog health in Agile
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- Bachelor's degree
- Undergraduate degree or equivalent experience
- Experience: 8+ years in Data Science with 3+ years leading DS initiatives
- Experience with model governance, monitoring, data quality practices in PHI compliant settings
- Databricks expertise (PySpark, Spark MLlib/scikit learn, MLflow, Delta)
- Proven solid statistics and ML (sampling, leakage control, class imbalance, time series, anomaly detection).
- Proven excellent stakeholder communication and decision influence.
Preferred Qualifications:
- Master's degree
- Exposure to Call Center (member & provider), Provider RCM, and EHR/clinical data
- Fraud/Waste/Abuse analytics, graph methods, causal inference, or pricing/actuarial exposure
- Experience with Feature Store design and model serving patterns
- Actuarial & Forecasting Analytics exposure
Scientist Responsibilities: (manager discretion if AI responsibilities are already present in JD):
Collaborate with research, engineering, and product teams to translate cutting-edge AI advancements into production-ready capabilities. Uphold ethical AI principles by embedding fairness, transparency, and accountability throughout the model development lifecycle.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.