Senior Manager, Machine Learning - Fraud, Waste and Abuse

You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Manages the design and development of scalable software solutions utilizing statistical, artificial intelligence (AI), and machine-learning (ML) modeling approaches. Performs and oversees research and testing to develop machine learning algorithms and predictive models. Conducts and reviews model training and evaluation. Integrates, tests, tunes, and monitors solutions.

• Leads the design, development, and maintenance of predictive analytics, machine learning, and artificial intelligence solutions, making specific determinations about overall performance, reliability, and scalability

• Collaborate with multiple partner teams such as Business, Technology, Product Management, Legal, Compliance, Strategy and Business Management to develop use cases and to deploy solutions into production

• Communicates advanced ML/AI concepts to senior leadership to facilitate decision making

• Works cross functionally with product managers, data scientists, and engineers to understand, implement, refine, and design machine learning and other algorithms

• Maintains knowledge of new learning approaches, technology, and tools through continuous research to ensure currency of solutions

• Drives innovative ideas and act as one of the thought leaders in identifying and selecting use cases for applicability of machine learning, appropriate modeling techniques and technologies, and determines success criteria and implementation methodologies

• Manages the hiring and training of new and existing staff, conducts performance reviews, and provides leadership, technical guidance, and coaching

• Shares knowledge and develops staff capabilities to strengthen understanding of business issues and best practices

• Develops and communicates organizational objectives; inspires and motivates team members to achieve results

• Responsible for the establishment and maintenance of Agile Scrum ceremonies and methodologies on the team

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience:

• Requires a Bachelor's degree and 6+ years of related experience, including prior management experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

• Experience in fraud/waste/abuse identification and investigation, provider billing, or clinical coding preferred.

• Knowledge of Home Health/Hospice and/or Behavioral Health billing, typical practice, and areas of potential FWA preferred.

Technical Skills:

• Knowledge of statistical analysis

• Knowledge of building predictive models

• Experience leading engineers through technical impediments and production support

• Experience with cloud computing environments, Spark, creating database schemas, continuous integration/continuous deployment, SQL, Python, REST APIs preferred

• Experience building ML/AI models using common methods within Python

• Knowledge of JIRA and Agile methodologies

Soft Skills:

• Ability to lead/manage others

• Collaboration and team building skills

• Effectively coaches and delivers constructive feedback

• Instills commitment to organizational goals

• Ability to communicate and make recommendations to upper management

• Effective conflict management skills

• Develops and delivers effective presentations

• Demonstrated negotiation skills

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act