Data Scientist

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.  

As a Medicare Risk Adjustment Data Scientist, you will play a critical role in developing, enhancing, and operationalizing AI/ML solutions that support Medicare Advantage risk adjustment programs. This role combines strong analytical thinking with applied machine learning and close collaboration with business and clinical stakeholders.

This position sits within OI Clinical Solutions - Decision Intelligence. Upon selection, you will be part of a high impact team delivering best in class analytics and AI solutions aligned to CMS Medicare Advantage business needs.

Primary Responsibilities:

• Partner with business, clinical, and technical stakeholders to translate business problems into data science solutions and analytical frameworks
• Develop actionable insights and clearly communicate findings and recommendations to internal and external stakeholders, including leadership
• Design, develop, and evaluate machine learning models (predictive and prescriptive) using structured and unstructured healthcare data
• Apply AI/ML techniques across use cases such as risk adjustment analytics, NLP based chart review, and documentation analysis
• Perform feature engineering, model training, validation, and performance evaluation to ensure robust and explainable outcomes
• Leverage UHG's big data ecosystem (Python, PySpark, Spark, Hive, Cloud platforms) to solve large scale analytical problems
• Collaborate with data engineering and platform teams to ensure models are production ready and scalable
• Stay current with emerging tools, techniques, and methodologies in AI/ML, NLP, and Generative AI
• 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 or Master's degree in Engineering, Computer Science, Mathematics, Statistics, Economics, or a related quantitative field
• 2+ years of hands on experience in Data Science / AI / Machine Learning roles
• Hands on experience with Deep Learning techniques (e.g., CNNs, RNNs, Transformers) applied to real world problems
• Experience in Natural Language Processing (NLP) including text classification, NER, summarization, or similar tasks
• Solid foundation in machine learning techniques such as Logistic Regression, Random Forest, Gradient Boosting (XGBoost), SVM, etc
• Good working knowledge of LLMs and Generative AI, including applied use cases
• Solid programming skills in Python / PySpark
• Proven excellent analytical, problem solving, and communication skills, with the ability to present insights to non technical audiences

Preferred Qualifications:

• 2+ years of experience using Python, Spark, and Hive in large scale analytics or ML environments
• 2+ years of hands on experience developing and evaluating AI/ML models
• Practical experience applying Deep Learning and NLP techniques
• Working experience on cloud platforms, preferably Azure, including familiarity with cloud based data storage and compute services used for analytics and ML workloads
• Understanding of Medicare Risk Adjustment programs and workflows
• Familiarity with CMS datasets such as MMR, MOR, EDPS, or related data sources

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.