Manulife · 1 week ago
Data Scientist - Health Fraud Analytics
Boston, MA
Full-time
Hybrid
Mid, Senior Level
$90K/yr - $167K/yr
5+ years expManulife is a leading international financial services provider, and they are seeking a highly technical and creative Data Scientist to join their Long Term Care Insurance fraud analytics and AI team. The role involves developing predictive models and sophisticated detection systems to protect policyholders from fraudulent claims while ensuring legitimate claims are processed efficiently.
FinanceFinancial ExchangesFinancial Services
Responsibilities
Develop predictive models analyzing patient health trajectories over multi-year periods to identify statistically improbable recovery patterns or care progression anomalies
Build longitudinal cohort analysis frameworks to detect unusual claim patterns across similar patient populations
Build temporal feature engineering pipelines that capture disease progression, treatment response patterns, and care critical issue trends
Design early warning systems for claims that deviate from expected long-term care utilization patterns
Analyze provider billing sequences to identify unusual patterns in care delivery, service combinations, or billing timing
Develop session-based analysis of claimant interactions with care providers to detect orchestrated fraud schemes
Build behavioral profiles of legitimate vs. fraudulent claim submission patterns
Develop anomaly identification systems for provider practice trends and claimant care utilization behaviors
Deep analysis of long-term care service codes, daily benefit triggers, and activities of daily living assessments
Develop expertise in long-term care assessment tools (e.g., nursing home assessments, home care evaluations)
Build validation systems for medical necessity determinations and benefit eligibility criteria
Create automated systems to detect inconsistencies between medical documentation and claimed care needs
Analyze provider networks for suspicious patterns in licensing, credentialing, and service delivery capabilities
Develop risk scoring systems for care providers based on claim patterns, licensing history, and network relationships
Build systems to validate provider capacity claims against actual service delivery patterns
Develop monitoring mechanisms for provider connections and potential collusion indicators
Qualification
Required
PhD or MS Bioinformatics, Computer Science, Clinical Research, or related quantitative field
5+ years of experience in healthcare analytics or related field
Expert-level proficiency in a coding language such as C, C++, Python, R
Expert level proficiency in SQL
Experience with time series analysis, survival analysis, and longitudinal data modeling
Proficiency with graph analytics, sequence mining, network analysis, and behavioral pattern recognition
Knowledge of healthcare delivery systems
Knowledge of medical coding systems (ICD-10, CPT, HCPCS) and healthcare reimbursement models
Familiarity with long-term care insurance products, benefit structures, and claims processes
Understanding of healthcare provider credentialing and licensing requirements
Understanding healthcare fraud typologies and detection methodologies
Advanced statistical modeling and machine learning expertise
Experience with unsupervised learning, anomaly detection, and imbalanced classification problems
Strong feature engineering capabilities, particularly for temporal and sequential data
Experience with model validation, performance monitoring, and regulatory compliance frameworks
Benefits
Health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage
Adoption/surrogacy and wellness benefits
Employee/family assistance plans
Various retirement savings plans (including pension/401(k) savings plans and a global share ownership plan with employer matching contributions)
Financial education and counseling resources
Up to 11 paid holidays
3 personal days
150 hours of vacation
40 hours of sick time (or more where required by law)
Company
Manulife
Manulife is a leading international financial services group that helps people make their decisions easier and lives better.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$3.31B2025-12-02Post Ipo Debt· $1B
2024-06-11Post Ipo Debt· $363.5M
2023-03-07Post Ipo Debt· $1.2B
Leadership Team
Phil Witherington
President and CEO
Steve Finch
President and CEO, Manulife Asia
Recent News
Alternative Credit Investor
2026-01-03
Canada NewsWire
2025-12-22
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