Senior Data Scientist - Prior Authorization

We are looking for a Senior Data Scientist with 5+ years of relevant experience to support a range of data science initiatives focused on reducing prior authorization (PA) operations cost. The work includes using models to auto-approve PAs, supporting quality improvement initiatives, driving process improvements that increase automation, and reducing fax-related costs. This role acts as a project lead on ambiguous problems, owning them from business framing through technical execution and rollout., * End-to-End Project Leadership: Lead ambiguous initiatives from problem definition and business framing through technical execution and rollout.

• Business Impact: Translate model metrics and analyses into business impact (e.g., operations savings, member experience, drug cost) and clear action plans.
• Production LLM Development: Build, deploy, and maintain production LLM applications, prompt pipelines, and alert logic using Python and SQL.
• Document AI Architecture: Evolve simple LLM workflows into high-precision systems featuring grounded reasoning, exact citations, and related techniques.
• Validation & Sampling: Design rigorous validation approaches, including targeted/stratified sampling and unbiasing techniques, to accurately estimate true population performance.
• Human-in-the-Loop Evaluation: Run SME ground-truth review programs to measure true model accuracy.
• Stakeholder Engagement: Partner with pharmacists, operations, and technical teams to learn clinical concepts (e.g., clinical criteria), explain trade-offs, and gain stakeholder buy-in.

• 5+ years of relevant experience as a data scientist or in a comparable applied role.
• Demonstrated ownership of ambiguous projects from business framing through rollout.
• Hands-on experience building, deploying, and maintaining production LLM applications.
• Experience running human-in-the-loop (SME) ground-truth review programs.

Skills

• Strong Python and SQL skills.
• Strong grasp of validation design, specifically targeted/stratified sampling and unbiasing techniques.
• Technical vision to evolve LLM workflows into high-precision document AI systems (grounded reasoning, exact citations).

Other

• Outcome-oriented mindset focused on measurable business value.
• Excellent communication across technical and non-technical teams, with the ability to explain trade-offs and gain stakeholder buy-in.
• Growth mindset and agility to quickly learn clinical concepts., * Prior healthcare, pharmacy, or benefits data experience.

• Competitive, market-aligned compensation.
• Remote flexibility within a collaborative work environment.
• Opportunity to work on high-impact healthcare analytics and AI initiatives with cross-functional clinical, operations, and technology teams.

We are a leading healthcare organization dedicated to improving the health and well-being of the millions of people we serve. As part of our pharmacy benefits operations, we work to make prescription medications more accessible, affordable, and easier to manage for our members. Our core values emphasize innovation, collaboration, and a member-centric approach, fostering an inclusive and supportive workplace for all employees.