Solutionec Private Limited

Job Summary

The Data Scientist / Analyst Consultant will design, develop and deploy advanced analytics and AI/ML models to detect fraud, waste and abuse across the AB PM-JAY ecosystem. The role involves working with large volumes of claims, beneficiary, provider and transaction data, engineering fraud features, building and validating detection triggers, and converting model outputs into investigation-ready suspicious claims and cards. The Data Scientist will build triggers using advanced analytics techniques including NLP, OCR, Social Network Analysis and deep learning, support their validation with the National Anti-Fraud Unit (NAFU), and continuously improve model efficacy based on feedback and confirmed fraud outcomes.

Key Responsibilities

• Design, develop and deploy statistical and machine learning models for fraud, waste and abuse detection on scheme claims and card data.

• Perform advanced data analytics including clustering, classification, profiling, anomaly detection, predictive modelling, scoring, regression, link prediction, co-occurrence grouping, similarity matching and causal modelling.

• Develop fraud detection triggers using advanced analytics techniques such as NLP, OCR, Social Network Analysis and deep learning, and document trigger construct, logic and thresholds for review and approval.

• Apply both supervised and unsupervised learning approaches, training models on labelled historical fraud data and scheme ecosystem data.

• Conduct data profiling, quality assessment, cleaning, standardisation and feature engineering to create analysis-ready datasets.

• Execute triggers and models on claim and card data within defined turnaround timelines and generate case-level suspicious output with trigger reasons and evidence fields.

• Validate model outputs, assess false positive risk, calibrate thresholds and measure trigger efficacy against defined performance benchmarks. • Fine-tune and retrain models on the basis of subsequent events, reviewer feedback and confirmed fraud outcomes.

• Collaborate with medical experts, business analysts, subject matter experts and technology teams to translate domain knowledge and clinical rules into executable analytical logic.

• Prepare model documentation, trigger submission packs, dashboards and reports for internal review committees and client-facing evaluations. 

Preferred Skills

• Experience in healthcare analytics, health insurance claims analytics or fraud, waste and abuse detection.

• Experience in fraud analytics roles with a proven track record of developing and implementing fraud detection models and strategies.

• Knowledge of AB-PMJAY / health benefit packages / claims adjudication workflows.

• Exposure to Social Network Analysis, graph analytics or link analysis for collusion and network detection.

• Familiarity with OCR, image analytics and document forgery or duplication detection.

• Experience with model deployment, versioning and MLOps practices.

• Exposure to dashboarding and BI tools such as Power BI, Tableau or equivalent. 

Experience

• Minimum 5 years of experience in analytics and managing big data, out of which at least 3 years in developing AI/ML models.

• Demonstrable credentials of having worked on and developed AI/ML models independently.

• Experience in fraud analytics, anomaly detection or risk modelling will be preferred.

• Experience in healthcare, health insurance or government health scheme data will be an added advantage.

The Qlicksense Architect is responsible for the assessment of business requirements, collection and identification of technical specifications, and the subsequent development of technology solutions that require development to be viable.

Applying architectural and engineering concepts to design a solution that meets operational requirements, such as scalability, maintainability, security, reliability, extensibility, flexibility, availability and manageability

What more?

• Hands-on experience 5 + in Qlik Sense development, dash boarding and data modelling and reporting (ad hoc report generation) techniques.
• Must be good at Data transformation, the creation of QVD files and set analysis.
• Experienced in application designing, architecting, development and deployment using Qlik Sense. Must be efficient in front-end development and know visualization best practices.
• Strong communication skills (verbal/written) to deliver technical insights and interpret the data reports to the clients. It also helps in understanding and serving the client’s requirements.
• Leadership qualities and thoughtful implementation of Qlik Sense best practices in order to deliver effective Qlik Sense solutions to the users.
• Able to comprehend and translate complex and advanced functional, technical and business requirements into executable architectural designs.
• Creating and maintaining technical documentation.
• Experienced in data integration through extracting, transforming and loading (ETL) data from various sources.
• Experience with healthcare a plus

Are you someone with a strong technology leadership background?

At Solutionec, we are looking for a Solution Architect professional who will work on complex and critical technology programs. Also, this role will allow you to engage in new and emerging technology and play an active role in Solutionec’s journey to the cloud.

In close partnership with business and IT partners, you will provide technical leadership and vision, authoring multi-year architecture roadmaps, and actively promoting opportunities to optimize, consolidate, reuse, and simplify. You will author actionable architecture solutions that achieve business goals, align with Solutionec technology strategy, and promote standard methodologies in design and architecture.

• 10+ years’ experience which include analysis, design, architecture, and development along with leadership skills
• Experience with Java/ C/Python is a must.
• Experience hands on full stack architect with deep expertise in architecture design tools and in open source technologies/frameworks such as PostgreSQL, Ceph, Memcached, Redis, MongoDB, Nginx, Tomcat, Apache, angular/react, nodejs, spring boot
• Experience with TSQL/SSRS/SSIS/SSAS/Informatica
• Experience leading multiple, full lifecycle, large-scale Data Migration Projects
• PostgreSQL Database Administrator with proven experience in large scale data migration from SQL Server to PostgreSQL
• Experience with complex end to end Cloud migrations to AWS/Azure
• Experience in cloud technologies including designing solutions that use AWS services such as EKS, RDS, S3, ALB, CloudWatch, ElastiCache and Lambda
• Experience in the consulting field with excellent leadership, customer service, oral and written skills, project pricing, and presentation skills
• Certified Solutions Architect with one of the major cloud providers will be a plus
• Experience with healthcare a plus