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Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # Decision Scientist - **Company:** CVS Health - **Location:** United States - **Experience:** Experienced - **Salary:** $64,890.0 - $173,040.0 - **Contract:** Permanent contract - **Skills:** Artificial Intelligence, Data Analysis, Clinical Data Repository, Data Visualization, Programming Tools, Fraud Prevention and Detection, R (Programming Language), Health Information Management, Python (Programming Language), Machine Learning, Operational Data Store, Power BI, SAS (Software), SQL Databases, Tableau (Software), Analytic Functions, Data Analytics, QNXT - **Published:** September 28, 2026 - **Apply:** https://www.indeed.com/viewjob?jk=b0b7a5ded298d8b5 ## About the Role * Minimum 3 years of experience in clinical coding, clinical consulting, healthcare auditing/analytics, or related analytical functions in claim systems such as ACAS, QNXT, HRP. * Experience developing business rules, performing trend analysis, and identifying program improvement opportunities. * Experience with SAS, SQL, Python, R, or other analytical programming tools and analyze large healthcare datasets * Experience applying statistical analysis, trend identification, or predictive methodologies to solve business problems * Ability to translate complex data findings into actionable business recommendations. * Demonstrated ability to communicate clinical and analytical concepts to technical and non-technical audiences. * Strong project management and organizational skills. * Experience developing business cases and quantifying financial impact Preferred Qualifications * Certified Professional Coder (CPC). * Accredited Healthcare Fraud Investigator (AHFI®). * Experience supporting SIU investigations and FWE programs. * Experience with predictive analytics, AI-assisted analytics, or machine learning methodologies. * Experience with machine learning, artificial intelligence, or anomaly detection techniques. * Experience developing dashboards using Power BI, Tableau, or similar visualization tools. Core Competencies * Strong analytical, critical-thinking, and problem-solving skills. * Ability to quantify financial opportunity and evaluate return on investment (ROI). * Ability to communicate analytical findings through compelling narratives, visualizations, and executive presentations. * Ability to connect tactical analytics work to enterprise affordability and payment integrity objectives. * Curiosity and willingness to challenge existing processes through data-driven recommendations. * Ability to independently manage multiple priorities in a fast-paced environment. * Strong attention to detail and commitment to quality. * Excellent written, verbal, and presentation communication skills. * Ability to influence and collaborate with cross-functional stakeholders. * Strong business acumen with the ability to connect analytical findings to operational and financial outcomes. Education * Bachelor's degree in Business Analytics, Data Science, Healthcare Administration, Statistics, Economics, Nursing, Health Information Management, or a related field preferred. * Equivalent combination of education and relevant work experience considered. ## Description The Decision Scientist supports Payment Integrity, Special Investigations Unit (SIU), Analytics & Behavior Change (A&BC), and Clinical Policy initiatives through advanced analytics, opportunity identification, and business rule development. This role transforms complex healthcare data into actionable insights that drive affordability, strengthen fraud, waste, and error (FWE) detection, and improve operational performance. The Decision Scientist collaborates with cross-functional stakeholders to evaluate opportunities, develop analytical solutions, validate business rules, and deliver measurable business value., 1. Ideation Management and Opportunity Development * Facilitate the intake, assessment, prioritization, and tracking of affordability, fraud, waste, error, and Payment Integrity opportunities. * Conduct preliminary assessments, business case development, and value estimation activities for potential concepts. * Maintain ideation inventories and support documentation to ensure transparency and progress tracking. * Quantify opportunity value, implementation complexity, and projected business impact to support prioritization decisions. * Collaborate with stakeholders to advance ideas from concept through evaluation and implementation. 2. Clinical and Healthcare Subject Matter Expertise * Apply healthcare industry knowledge, coding expertise, and policy interpretation to support the identification and evaluation of fraud, waste, error, and payment integrity risks * Utilize clinical knowledge to help interpret billing patterns, evaluate medical necessity, and ensure analytical approaches aligned with enterprise policy, healthcare industry standards and regulatory requirements. 3. Advanced Analytics and Business Rule Development * Conduct exploratory, descriptive, predictive, and diagnostic analyses using claims, provider, member, and operational data. * Develop, test, and refine business rules, algorithms, and analytical methodologies that identify emerging fraud, waste, error, and payment integrity risks. * Partner with business stakeholders to translate operational challenges into analytical solutions. * Validate analytical outputs and detection methodologies to optimize effectiveness while minimizing false positives. * Measure and report business impact associated with implemented solutions. 4. Technical Review and Quality Assurance * Perform quality review and validation of analytical methodologies, business rules, and technical implementations to ensure accuracy, consistency, and operational effectiveness. * Collaborate with technical teams to ensure analytical solutions are accurately implemented, validated, and maintained throughout the development lifecycle. 5. Communication and Recommendations * Analyze and synthesize complex analytical results into meaningful and actionable information for investigators, business partners, and leadership. * Communicate findings in a clear and concise manner that supports informed decision-making, operational improvements, and strategic planning. * Develop evidence-based recommendations that improve investigative outcomes, strengthen fraud detection capabilities, reduce financial losses, and enhance operational efficiency. * Support stakeholders in evaluating risks, opportunities, and potential impacts associated with proposed actions. 6. Strategic Business Collaboration * Build strong partnerships across SIU, FWE, payment integrity, compliance, clinical operations, and other business areas to understand strategic priorities and organizational objectives. * Collaborate to design analytical solutions that align with enterprise goals, improve program integrity, and deliver measurable business value. * Influence cross-functional stakeholders by balancing business objectives, operational feasibility, regulatory requirements, and financial impact. 7. Continuous Improvement and Innovation * Identify opportunities to enhance analytical methodologies, business rules, and investigative processes through automation and advanced analytics. * Evaluate new data sources, AI-enabled capabilities, and emerging technologies to improve detection effectiveness and operational efficiency. * Leverage automation, AI-enabled tools, and emerging analytical techniques to improve scalability, productivity, and detection effectiveness. ## Related Videos - [Data Science in Retail](https://www.wearedevelopers.com/videos/586-data-science-in-retail) - [Beyond Dashboards: Fixing Text-to-SQL with Semantic RAG](https://www.wearedevelopers.com/videos/2036-beyond-dashboards-fixing-text-to-sql-with-semantic-rag) - [Data Science on Software Data](https://www.wearedevelopers.com/videos/162-data-science-on-software-data) - [AI in High-Stakes Industries: Lessons Learned](https://www.wearedevelopers.com/videos/100253-ai-in-high-stakes-industries-lessons-learned) - [REST, GraphQL, gRPC, and more: A comparison of modern API styles](https://www.wearedevelopers.com/videos/100247-rest-graphql-grpc-and-more-a-comparison-of-modern-api-styles) - [Blueprints for Success: Steering a Global Data & AI Architecture](https://www.wearedevelopers.com/videos/1577-blueprints-for-success-steering-a-global-data-ai-architecture) ## Related Articles - [Data Analyst Salary in the UK](https://www.wearedevelopers.com/magazine/278-data-analyst-salary-in-the-uk) - [What Industries Outside of AI Are Hiring The Most AI Experts?](https://www.wearedevelopers.com/magazine/98-what-industries-outside-of-ai-are-hiring-the-most-ai-experts) - [Best Coding Boot Camps in Germany](https://www.wearedevelopers.com/magazine/237-best-coding-boot-camps-in-germany) - [Highest Paying Tech Companies for Developers](https://www.wearedevelopers.com/magazine/220-highest-paying-tech-companies-for-developers) - [Coffee with Developers - Maria Apazoglou - Making AI understandable for all in production](https://www.wearedevelopers.com/magazine/475-coffee-with-developers-maria-apazoglou-making-ai-understandable-for-all-in-production) - [Top Big Data Technologies That You Need to Know](https://www.wearedevelopers.com/magazine/108-top-big-data-technologies-that-you-need-to-know)