Staff Data Scientist, Fraud and Billing

About Machinify

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients nationwide. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify integrates a fully configurable and content-rich, AI-powered platform with best-in-class expertise. We are constantly reimagining industry possibilities, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

The Opportunity: Staff Data Scientist, Fraud and Billing

We are seeking a Staff Data Scientist, Fraud and Billing to lead the build and deployment of classical ML and GenAI systems. This role focuses on generating and validating billing error, audit, and fraud concepts within healthcare payments. You will partner with Subject Matter Experts (SMEs) and cross-functional stakeholders to deliver production-grade capabilities that demonstrate clear customer and financial impact.

What You Will Do

• Build and ship classical ML and GenAI pipelines that surface, rank, and explain candidate billing error, audit, and fraud concepts across large-scale healthcare claims data.
• Advance state-of-the-art research in anomaly detection, information retrieval, and weak supervision, transforming research into robust production systems.
• Accelerate concept generation and validation with SMEs by designing human-in-the-loop workflows, enabling high-throughput review with strong precision, recall, and traceability.
• Own end-to-end delivery from problem framing and data strategy to model development, evaluation, deployment, and monitoring, prioritizing reliability and customer outcomes.
• Partner cross-functionally with Product, Data Engineering, Operations, SMEs, and business leaders to prioritize work, unblock execution, and unlock material financial value.
• Help scale the team and platform as Machinify aggressively grows toward resale and IPO readiness.

What You Bring

• Degree in Computer Science, Engineering, or a related field.
• 10+ years of data science experience, with at least 5 years in a leadership role, including a leadership role at a start-up.
• Proven track record of managing data teams and delivering complex, high-impact products from concept to deployment.
• Strong knowledge of data privacy regulations and best practices in data security.
• Exceptional team management abilities, with experience in building and leading high-performing teams.
• Ability to think strategically and execute methodically.
• Ability to drive change and inspire a distributed team.
• Strong problem-solving skills and a data-driven mindset.
• Ability to communicate effectively, collaborating with diverse groups to solve complex problems.
• You embrace challenges with optimism, a balanced approach, and bring a business-oriented perspective to product development.
• You prioritize customer impact, ensuring your work significantly advances our product value.

What We Offer

• Work from anywhere in the US! Machinify is digital-first.
• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary, 401(k) with company match
• Unlimited PTO
• Additional health and wellness benefits and perks
• Flexible and trusting environment where you’ll feel empowered to do your best work.

Key skills/competency

• Data Science
• Machine Learning
• Generative AI
• Fraud Detection
• Healthcare Analytics
• Anomaly Detection
• Information Retrieval
• Weak Supervision
• Cloud Platforms
• Leadership