Interview guides · Boston Scientific

Boston Scientific Data Scientist Interview Questions & Guide 2026

Modeling drills for a Boston Scientific data scientist interview: baselines, regression interpretation, class imbalance, model defense.

The 60-second brief

A Data Scientist at Boston Scientific plays a pivotal role in bridging the gap between complex medical device data and actionable clinical or operational insights. You are not just building models; you are contributing to solutions that directly impact patient outcomes, healthcare efficiency, and the advancement of medical technology. By leveraging data from across the organization, you help translate raw information into strategic decisions that drive innovation in a highly regulated and mission-critical environment.

When randomisation is off the table, the skill being checked is naming an identification strategy together with the assumption it rests on: parallel trends for difference-in-differences, relevance and exclusion for an instrument, overlap and conditional ignorability for matching. Say the assumption out loud and say how you would try to break it.

Focus areas

Build member-month denominators from overlapping coverage spans
Reconstruct drug exposure intervals from dispensing records
Risk-adjust outcomes before comparing providers or panels

Overview

This role requires a unique blend of technical rigor and product-oriented thinking. You will collaborate with cross-functional teams—including engineering, clinical research, and product management—to solve high-stakes problems. Whether you are optimizing device performance, analyzing clinical trial data, or designing experiments to improve patient care, your work is fundamental to maintaining Boston Scientific's position as a leader in the global medical device market.

While the work is highly technical, remember that at Boston Scientific, your ability to communicate complex findings to non-technical stakeholders is just as important as your model accuracy. Always tie your technical solutions back to the end-user or business outcome.

The Boston Scientific interview process

Boston Scientific candidates report 5 rounds · ≈ 4-6 weeks. The stages below are what candidates describe, not a published process.

Initial Screening

Most candidates lose this call inside the first two minutes, during the walkthrough of their own background. The account runs chronologically, sits at the level of tools and titles, and never arrives at a decision anyone could have disagreed with. Anchor on a problem instead of a timeline: what the team could not answer, what you did about it, what happened next. Ninety seconds is enough, and stopping on time leaves room for the half of the call that belongs to you. What you ask about how work gets prioritised signals your level more reliably than the walkthrough does.

What to demonstrate

Whether your background summary has a shape (problem, decision, consequence) or is a chronological list of tools and employers
Whether you can account for gaps, short stints and the reason you are looking, unprompted and without hedging
The substance of the questions you ask back, which an experienced screener reads as a level signal

How to prepare

Time your opening walkthrough against a clock. If it runs past two minutes, compress the earliest role into a single clause and spend the recovered time on the most recent one
Write one honest sentence for every gap or short stint visible on your resume and offer it before being asked about it
Prepare questions about how work arrives and gets prioritised: who writes the request, how often priorities change, and what happens to an analysis after it is delivered

Technical Assessments

A handful of shapes account for most of what gets asked in this format: a ranking or deduplication inside groups, a running or rolling total, a period-over-period comparison, and a cohort tracked forward over time. Recognising the shape quickly is most of the speed here; deriving it from scratch while a clock runs is where the time goes. Know that a window function keeps every row while a GROUP BY collapses them, and know which one the question needs. If the exercise is in Python instead of SQL, the same shapes arrive as groupby with transform, shift and merge, and the same grain mistakes are available.

What to demonstrate

Whether you reach the right construct without a detour, such as ROW_NUMBER over a partition to deduplicate instead of a self-join against a MAX subquery
Whether you know what your window frame actually is, since adding ORDER BY inside OVER changes the default frame and silently changes a running total
Whether the thing runs. A near-miss that throws an error scores below a plainer query that returns the right rows.

How to prepare

Write each of the four shapes once from memory against a small schema and keep the working version somewhere you will reread it: dedupe with ROW_NUMBER, a running total, a month-over-month change with LAG, and a retention table
Compute one running total twice on data with tied timestamps, once on the default frame and once with ROWS BETWEEN UNBOUNDED PRECEDING AND CURRENT ROW, and look at where the two disagree
If Python is on the table, rebuild the dedupe and the running total with groupby and cumsum, then assert the two implementations return identical rows

Case Study Interview

This round runs as a working session, so part of what it decides is whether you are useful to think with. The interviewer will interrupt: a hint that the data you assumed does not exist, a challenge to your metric, a nudge toward a branch you skipped. Treating those as interference is the common failure. Reason out loud while your thinking is still provisional so there is something to react to, and when a redirect arrives, take it instead of defending the path you had already started down.

What to demonstrate

Whether your reasoning is audible while it is still unsettled, or only after you have privately decided
What you do with a hint: absorb it and adjust, or argue for the original route
Whether your clarifying questions have answers that would change your approach, as opposed to filling silence
Whether you can be wrong about something in the middle of the case and keep moving without restarting

How to prepare

Run practice cases with a partner instructed to interrupt twice: once to remove a data source you assumed existed, once to reject the metric you chose. Practise absorbing both without going back to the start.
Before each practice case, write down the clarifying questions you plan to ask, then check afterwards whether any answer actually changed what you did. Drop the ones that did not.
Explain an analysis you already know well to someone outside the field and have them stop you at every point where the reasoning jumped a step.

Peer and Supervisor Interaction

Rounds outside the standard loop often open with something deliberately under-specified: a loose business problem, an open question about a product area, a dataset described in one sentence. The common failure is surveying, listing six plausible approaches and committing to none of them. The thing that separates a strong answer is scoping out loud. State what you are treating as the goal, name the metric you would move, say what you are choosing not to do and why, then take one path through to an actual answer. An interviewer can follow you down a narrow path. Nobody can grade a menu.

What to demonstrate

Whether you turn an ambiguous prompt into a stated question with a measurable outcome before doing any work
The judgement visible in what you cut, and whether you say why you cut it rather than silently dropping it
Whether you land on a concrete recommendation with its caveat attached, rather than an unranked set of options

How to prepare

Take three vague prompts, such as 'is this feature working', 'why did retention drop', and 'should we expand into a new segment'. For each, write one sentence of goal, one primary metric with its window, and two things you are explicitly not doing.
Practise giving the recommendation first and the reasoning second, in five minutes. Loosely defined rounds are usually time-boxed, and an answer that arrives last often does not arrive.
Keep a running assumption list as you talk, on paper or in the shared doc, so the interviewer can challenge one assumption instead of your whole answer.

Leadership Interaction

An added round often puts you in front of someone outside the core hiring team: a partner engineer, a product owner, a domain expert, sometimes a more senior manager. The question they are really asking is not whether you can do the work but whether they would trust a number that came from you. That changes what a good answer looks like. Lead with what the decision cost and what it changed, keep the method available but not central, and be plain about the limits of your evidence. Overstating a result is the fastest way to lose this round.

What to demonstrate

Whether you can explain a technical choice to someone who will never read your code, without either flattening it into nothing or hiding inside jargon
Honesty about evidence strength: what the analysis establishes, what it only suggests, and what it cannot say at all
How you take disagreement, specifically whether you update on a good objection, hold your position with reasons, or fold on contact

How to prepare

Write the two-sentence version of your most technical project for a non-specialist, then check that neither sentence needs a method name to make sense.
For one result you are proud of, write the strongest objection someone could raise and a response that concedes the part of it that is correct.
Prepare one decision that turned out to be wrong: how you found out, what it cost, and what you changed afterwards. A senior cross-functional interviewer asks for this more often than a technical one does.

Where candidates lose points

Treating clinical measurements as missing at random

A lab result, a vital sign, or a screening exists because someone ordered it, and ordering tracks suspicion of disease, visit frequency, and site workflow. Imputing the mean or dropping incomplete rows biases the population estimate and can flip the sign of an association, because the untested are systematically healthier or systematically disengaged. The presence indicator is often more predictive than the value, which is a warning sign rather than a feature win: a model that learns test ordering will not transfer to a site with different protocols.

Rates built on member counts rather than exposure

Members join and leave mid-period, so dividing events by distinct members mixes a person covered for 30 days with one covered for 365. New joiners also have artificially low observed utilisation because their claims have not arrived yet and because care takes time to initiate. Denominators must be member-months or member-years, and comparative quality measures usually need a continuous-enrolment requirement with an explicit allowable gap, stated in days.

Building features from data that postdates the prediction time

Check every feature against the timestamp at which the model would actually score, and drop anything computed from a window that includes or follows the label event. For a forecasting use case, split train and test by time rather than at random, and split by entity when the same entity recurs.

Sizing estimates built on unnamed, unrevisable assumptions

Write each assumption as a named number you can change, then show the arithmetic so the interviewer can challenge one input instead of the whole answer. Finish by saying which assumption the result is most sensitive to, which matters more than the point estimate.

Questions & practice

Build a claims lag triangle and complete recent months

Medium · chain ladder · runout · pivot

medical_claim_line has claim_id, claim_version, frequency_code, service_start_date, paid_date, allowed_amount, claim_status. Using 24 fully mature incurred months, build a development triangle of allowed dollars by incurred month and payment lag in whole months, derive cumulative completion factors by chain ladder, then estimate ultimate allowed for the three most recent incurred months at a stated paid-through date. Deduplicate to surviving claim versions before building the triangle. Return incurred_month, paid_to_date, completion_factor, estimated_ultimate.

Approach

Deduplicate to surviving claim versions and keep paid lines first. A triangle built on all versions develops on adjustment churn rather than on payment timing, and replacements arrive late, so the distortion concentrates in exactly the tail you are trying to estimate.
Compute lag as a whole-month difference between incurred month and paid month, not as day difference divided by 30. Ragged month lengths otherwise shuffle identical claims between lag buckets depending on which month they fall in.
Pivot to incurred_month by lag, cumulate along lag, then form age-to-age factors as the ratio of the column L+1 total to the column L total, summed over incurred months mature enough to have both. Volume weighting is the chain ladder; a simple mean of per-month ratios lets one low-volume month dominate the factor.
Chain the age-to-age factors from each lag to ultimate and invert: completion factor at lag L is the reciprocal of the product of factors from L onward. Apply as estimated_ultimate = paid_to_date / completion_factor.
State the assumption you have just made, which is that the development pattern is stable. It is not, after a claims-system migration, a network change or a processing backlog, and the most recent month's factor is the least reliable because it rests on the fewest observations while carrying the largest adjustment.

Worked solution (35 min)

Deduplicate to surviving versions, drop voids, keep claim_status 'paid', and derive incurred_month from service_start_date and paid_month from paid_date.
lag = (paid_month.year - incurred_month.year) x 12 + (paid_month.month - incurred_month.month); drop negative lags and investigate them separately.
Pivot to a triangle of summed allowed_amount, cumulate along the lag axis, and mask cells past the paid-through date so no cell contains a future payment.
Compute volume-weighted age-to-age factors per lag over the mature rows, then chain them into cumulative completion factors.
Apply the factor for each recent month's current maturity to its paid_to_date and return the four columns.

Expected result: Three rows. Completion is well below 1 at short lag and approaches 1 in the tail; for a mixed medical book a one-month-old incurred month commonly sits far from complete, while a twelve-month-old one is close. Exact values are book-specific, so the reviewable property is monotonicity and the holdout test below, not the numbers themselves.

Verify it yourself

Cumulative completion factors are non-decreasing in lag and converge toward 1 at the tail.
Hold out one fully mature incurred month, apply the factors at each of its intermediate maturities, and confirm each estimate lands within a few percent of its known total.
estimated_ultimate is greater than or equal to paid_to_date for every row.
A pharmacy-only triangle completes far faster than an inpatient-facility-only triangle, which confirms the lag computation is reading real payment timing.

Follow-up

A processing backlog means the last two months developed slower than history. What does your estimate do, and how would you detect that before reporting?
Pharmacy, professional and inpatient facility develop on different clocks. How do you split the triangle, and what breaks if the service mix shifts?
What happens to a PMPM series if someone reports an unadjusted recent month, and in which direction does the error point?

Sessionise transfer chains into episodes, then count readmissions

Hard · sessionisation · cumsum grouping · readmission

encounter has encounter_id, patient_id, facility_id, encounter_type, admit_ts, discharge_ts, admission_type, discharge_disposition, is_planned_admission, principal_diagnosis_code. Chain acute-to-acute transfers into episodes of care: an inpatient encounter discharged as transfer_acute, followed by another inpatient encounter for the same patient at a different facility admitting within 24 hours of that discharge, belongs to the same episode. Then compute the 30-day unplanned readmission rate over episodes, excluding index episodes that are planned, that end in expired, hospice or against medical advice, or that are still open. Return encounter_id to episode_id, plus the rate.

Approach

Restrict to inpatient encounters for the chaining step and sort by patient_id, admit_ts. Observation and emergency encounters are not acute inpatient stays and pooling them changes both the chain and the denominator.
Build a boolean continues flag: the previous row is the same patient, its discharge_disposition is transfer_acute, its facility_id differs from this row's, and admit_ts minus previous discharge_ts is between 0 and 24 hours. Episode id = cumsum of the negation of that flag. This is the vectorised form of a sessionisation loop and is why the pattern generalises to any event stream.
Collapse to episode grain taking first admit_ts, last discharge_ts, last discharge_disposition, and any() of is_planned_admission. The episode inherits its exit state, not its entry state, which is why a transfer chain ending at home is one home discharge rather than two transfers.
Apply index exclusions at episode grain. Dropping episodes that end in death is not optional: a dead patient cannot be readmitted, so leaving them in inflates the denominator and depresses the rate for exactly the panels caring for the sickest members.
For each surviving index episode, find the next unplanned acute inpatient episode for that patient admitting within 30 days of the index discharge_ts. Count events at episode grain, since one patient can contribute several index episodes. Report the raw rate and say plainly that it is not comparable across panels without risk adjustment, which is what the observed-over-expected form exists for.

Follow-up

discharge_ts is null on an open stay in the middle of a chain. What does your flag do, and what should it do?
A patient is transferred out and then back to the originating facility within 24 hours. Should that chain, and does your facility_id condition handle it?
Is a readmission itself eligible to serve as a later index episode? Say what you chose and what the choice does to the rate.

Collapse claim versions before summing allowed amounts by member

Easy · claim versioning · groupby · deduplication

You are given medical_claim_line as a pandas DataFrame: claim_line_id, claim_id, claim_version, frequency_code (1 original, 7 replacement, 8 void), member_id, service_start_date, procedure_code, allowed_amount, claim_status. Return total allowed_amount per member for service dates in one stated calendar month, counting each claim once at its surviving version and excluding any claim whose surviving version is a void. Multi-line claims must keep every line of that surviving version. Output columns: member_id, allowed_amount, sorted descending. Do not deduplicate on claim_id alone.

Approach

Separate the two grains out loud before writing code: versions live at the claim level, dollars live at the line level. Every bug in this exercise comes from mixing them.
Compute the surviving version per claim with a groupby transform of max over claim_version, then keep the lines whose claim_version equals that value. A transform keeps the frame at line grain, which a sort plus head(1) does not.
Drop whole claims whose surviving version carries frequency_code 8. A void is not a zero-dollar line, it retracts the claim, so filtering rows rather than claims leaves the prior version's lines behind.
Filter to claim_status 'paid' and state the assumption: denied, pended and reversed lines carry an allowed_amount that never became a liability, so including them overstates cost.
Restrict service_start_date to the month boundaries, then groupby member_id and sum. Sort descending and return.

Follow-up

A claim has versions 1, 7, 7 where the second replacement has fewer lines than the first. What does your code return and is that correct?
How would you handle a claim whose lines span two calendar months at the boundary of the reporting window?
The same logic has to run over 400 million lines in a warehouse. What changes, and what stays the same?

Write a query using SQL window functions to calculate a rolling average of patient usage over the last 30 days.

Medium · sql and data manipulation

Approach

Handle the rows that do not match: a LEFT JOIN with a NULL check is usually the question.
State the window function and its partition and ordering out loud before writing it.
Check whether any join is one-to-many before aggregating, or the sums inflate.

Follow-up

How would you verify this result without re-running the same query?
What breaks if events arrive late or out of order?

How would you join multiple tables to identify users who dropped off after a specific event?

Medium · sql and data manipulation

Approach

Handle the rows that do not match: a LEFT JOIN with a NULL check is usually the question.
Check whether any join is one-to-many before aggregating, or the sums inflate.
State the window function and its partition and ordering out loud before writing it.

Follow-up

What breaks if events arrive late or out of order?
How would you verify this result without re-running the same query?

Count thirty-day unplanned readmissions without counting transfers

Medium · self-join · event streams · exclusions

encounter holds encounter_id, patient_id, facility_id, encounter_type, admit_ts, discharge_ts, admission_type, discharge_disposition, is_planned_admission and index_encounter_id. For inpatient stays discharged between 2025-01-01 and 2025-11-30, return the 30-day unplanned readmission rate overall and by facility_id. Exclude an index stay when is_planned_admission is TRUE or discharge_disposition is transfer_acute, expired, hospice or ama. A qualifying readmission is any unplanned inpatient admission for the same patient with admit_ts after the index discharge_ts and within 30 days of it. One stay can be both a readmission and the next index stay.

Approach

Decide between LEAD and EXISTS explicitly and say why. LEAD over the patient's admission stream gives the literal next stay, so an intervening planned admission hides a later unplanned one. The measure asks whether any unplanned admission fell in the window, which is an EXISTS or a self-join with a range predicate.
Exclude transfers at the index end before anything else. An acute-to-acute transfer closes one encounter and opens another at a different facility_id within hours, so without the transfer_acute exclusion the facilities that move the sickest patients out look the worst.
Apply the index exclusions as a set, including stays with NULL discharge_ts, which are still open and have no measurable window.
Stop the denominator early enough that every index stay had a full 30 days of observation plus encounter lag. That is why the window ends 2025-11-30 rather than at year end.
Compute the rate at stay level, not patient level, then compare the raw facility rates against an observed-over-expected framing before anyone publishes a ranking.

Worked solution (30 min)

CTE ip: inpatient encounters with a non-null discharge_ts.
CTE index_stays: ip rows with discharge_ts in the window, is_planned_admission FALSE, and discharge_disposition not in the four excluded values.
Flag each index stay with EXISTS against ip for the same patient_id where is_planned_admission is FALSE, encounter_id differs, admit_ts > index.discharge_ts and admit_ts <= index.discharge_ts + 30 days.
Aggregate numerator and denominator overall and grouped by facility_id.
Re-run with the transfer exclusion removed and record how much the rate moves.

Expected result: Eligible index stays, stays with a qualifying readmission, and the quotient, overall and per facility_id. Removing the transfer exclusion returns a higher rate, and the gap between the two is a number you should be able to quote.

Verify it yourself

Numerator never exceeds denominator, and an index stay with two qualifying readmissions still contributes exactly one.
No index stay in the output has discharge_disposition transfer_acute, expired, hospice or ama.
A 0-day window gives a rate of exactly 0, and a 365-day window gives a rate no lower than the 30-day one.
Facility rates weighted by facility denominators reconcile to the overall rate.

Follow-up

A patient has three stays ten days apart. How many index stays and how many readmissions, and why does the answer depend on the stated rule?
Which comparison would you publish across facilities, raw rate or observed over expected, and what does risk adjustment still fail to fix?
index_encounter_id already exists on the table. Would you trust it, and how would you audit it against your own logic?

How do you decide which metrics are "north star" metrics versus "health" metrics?

Medium · product sense and metrics

Approach

Decompose the metric into the rates that drive it, and say which one you would check first.
Restate the decision this analysis has to support, and who acts on the answer.
State what result would change your recommendation, so the answer is falsifiable.

Follow-up

What would you do if the primary metric and the guardrail moved in opposite directions?
How would you detect that the metric is being gamed rather than genuinely improving?

If we see a sudden drop in a key product metric, what steps would you take to diagnose the root cause?

Medium · product sense and metrics

Approach

State what result would change your recommendation, so the answer is falsifiable.
Fix the population and the time window before naming any metric.
Name one primary metric, then the guardrail that stops it being gamed.

Follow-up

How would you detect that the metric is being gamed rather than genuinely improving?
What would you do if the primary metric and the guardrail moved in opposite directions?

How would you measure the success of a new feature in a remote patient monitoring app?

Medium · product sense and metrics

Approach

Name one primary metric, then the guardrail that stops it being gamed.
State what result would change your recommendation, so the answer is falsifiable.
Fix the population and the time window before naming any metric.

Follow-up

What would you do if the primary metric and the guardrail moved in opposite directions?
How would you detect that the metric is being gamed rather than genuinely improving?

Design a dashboard for a product manager to track device engagement.

Medium · product sense and metrics

Approach

Name one primary metric, then the guardrail that stops it being gamed.
State what result would change your recommendation, so the answer is falsifiable.
Decompose the metric into the rates that drive it, and say which one you would check first.

Follow-up

Which segment would you cut first, and what would that rule out?
What would you do if the primary metric and the guardrail moved in opposite directions?

Walk me through the most common experimentation pitfalls you have encountered.

Medium · a/b testing and experimentation

Approach

Decide the analysis before seeing data, including how long it runs and when you look.
Name the guardrails that would stop a launch even on a positive primary result.
Say whether units interfere with each other, and switch design if they do.

Follow-up

What would you conclude if the result is positive but the test is underpowered?
What would you do if you could not randomise at all?

What would you do if an experiment shows a positive result but the confidence interval is very wide?

Medium · a/b testing and experimentation

Approach

Name the randomisation unit first; it decides the variance and what the test can detect.
Decide the analysis before seeing data, including how long it runs and when you look.
Name the guardrails that would stop a launch even on a positive primary result.

Follow-up

What would you conclude if the result is positive but the test is underpowered?
How would you handle interference between treated and control units?

Set the decision rule when cost and denial guardrails conflict

Medium · guardrail conflict · denials · non-inferiority bound · audit sampling

Utilization management is asked to cut risk-adjusted allowed PMPM, and its lever is prior authorization and first-pass denial on advanced imaging and specialty drugs. The scorecard guardrail is first-pass denial rate from medical_claim_line (claim_status, denial_reason_code, claim_version, received_date) paired with the overturn rate on appealed denials. The two move in opposite directions by construction. Write the decision rule: which metric binds, at what pre-declared threshold, who adjudicates a breach, and what happens on breach. Do not resolve the conflict by weighting both into one score.

Approach

Say why a composite is the wrong instrument: the weights get chosen after someone has seen which way the quarter went, and any weighted sum lets a large enough cost win purchase an unbounded increase in wrong denials. A guardrail is a constraint, not a term in an objective.
Sharpen what the guardrail is actually protecting. A higher denial rate is not by itself a harm, since some denied claims should be denied. The harm is denials that should not have been made, so split first-pass denials by denial_reason_code into administratively correctable ones (eligibility, coding, missing documentation) and clinical-necessity ones, and put the bound only on the clinical group.
Fix the measurement of the guardrail before setting its threshold: count the denominator at claim_version 1 so replacements (frequency_code 7) and voids (8) are not double counted, hold the month back for 60 days of adjudication runout, and report by received_date.
Get the direction of the appeal-selection bias right. Appeals are filed on the denials the appellant already believes are wrong, by the members and providers with the staffing, literacy and dollar threshold to file at all, and an appeal usually arrives carrying documentation the first adjudication never had. The overturn rate on appealed denials therefore runs well above the wrong-denial rate across all denials, often by a multiple, and it moves with filing behaviour as much as with adjudication quality. The unbiased population estimate is a blind re-review of a random sample of all denied clinical-necessity lines each quarter, judged on the record as it stood at first adjudication; the appeal series is a fast indicator read against its own history between audits, not a second estimate of the same quantity.
Write the rule as a bound with a consequence: risk-adjusted allowed PMPM is the primary and binds only while the audited wrong-denial rate stays within a pre-declared absolute margin of its trailing four-quarter mean. Breach stops the program's expansion rather than discounting its score, and the margin is set before the quarter opens.
Name the adjudicator and the cadence: a clinical owner outside the utilization function, reviewing at the stated paid-through date, with the breach consequence written down before any result is known.

Worked solution (25 min)

Restate the guardrail metric properly: numerator is claim lines denied at first adjudication, denominator is lines received in the month counted at claim_version 1, held 60 days, broken out by denial_reason_code group.
Split denial_reason_code into administratively correctable and clinical-necessity groups and say which function owns each, since the two have different fixes and different harms.
Write the appeal-selection argument in two sentences, including which way it runs, and specify the random blind re-review: the frame it is drawn from, namely all denied clinical-necessity lines rather than appealed ones, plus sample size, who reviews, what record they are shown, blinding, and quarterly cadence.
State the bound as an absolute margin on the audited wrong-denial rate against its trailing four-quarter mean, with the margin fixed before the period.
Write the breach consequence and the named adjudicator, and note that both are recorded before results exist.

Expected result: A written rule in which risk-adjusted allowed PMPM is primary; the binding guardrail is the audited wrong-denial rate on clinical-necessity denials, estimated from a blind random re-review of all denied clinical-necessity lines, with the appeal overturn rate kept as a between-audit indicator that runs above the audited rate and never sets the bound; the bound is a pre-declared absolute margin against a trailing four-quarter mean; a clinical owner outside utilization management adjudicates; and a breach halts expansion rather than adjusting a score.

Verify it yourself

Recount the denominator with and without version dedup. If the two differ by more than a percent or two, the incumbent number has been counting resubmissions.
Re-run a closed month at two extract dates 60 days apart. A moving denial rate means the runout hold is too short.
Compare the audited wrong-denial rate to the appeal overturn rate for the same quarter. The overturn rate should be the higher of the two, usually by a multiple, because appeals are filed on the denials most likely to be wrong and often add documentation the first adjudication never saw. An audit rate at or above the overturn rate is the anomaly: check that the sample was drawn from all denied clinical-necessity lines rather than only appealed ones, and that the reviewers were blinded and shown the record as it stood at first adjudication.
Confirm the margin, the adjudicator and the consequence are all recorded with a timestamp before the period's data was available.

Follow-up

Denials rose and the overturn rate fell. Give the benign reading and the bad reading, and the one number that separates them.
What happens to your bound if the appeal filing rate per denial drops 30 percent in the same quarter?
How large a random audit sample do you need to detect a 2 percentage point rise in wrong denials off a 6 percent base, and what does that cost in clinician review hours?

Adherence share collapsed the month a feed was added

Easy · pdc · interval sql · identity resolution

The share of members with proportion of days covered at or above 0.80 in one therapeutic class fell from 0.71 to 0.58 in a single month. pharmacy_claim carries fill_id, member_id, ndc_code, therapeutic_class_code, fill_date, days_supply, quantity_dispensed, refill_number, reversal_flag, reversed_fill_id and source_system_code. There is no person-level key above member_id and no enrollment table on hand, so every diagnostic has to run on pharmacy_claim alone. That month the pipeline began ingesting a second pharmacy source. Determine whether adherence actually changed, and hand back a PDC query you would defend line by line.

Approach

Compute controls that depend on neither member identity nor the PDC code: total fills in the class per month, and total days_supply dispensed in the class per month. Both are sums over rows, so neither moves when one person's fills split across two member_ids, which is exactly what a per-member control cannot promise. If both are flat while PDC falls, no dispensing behaviour changed and the computation or the keys did.
Check days_supply for nulls and zeros by source_system_code. If the new source omits days_supply and the code coalesces null to zero, covered days vanish and PDC falls even though the fills are there.
Check for member identity splitting using the columns you actually have. There is no person key above member_id, so the split has to be found by its footprint: distinct member_id in the class jumping at the break while total fills stay flat, and a rise in the share of member_ids whose earliest fill for a given ndc_code carries refill_number above zero, which is a continuation history that lost its beginning. When one person is split, each id may fall below the two-fill denominator requirement and drop out, and the ids that do survive carry artificial gaps.
Check reversals. A reversed fill is two rows, the fill and a row with reversal_flag TRUE pointing at reversed_fill_id, and both must be excluded from exposure. If the new source expresses reversals differently and reversed_fill_id does not link, phantom coverage appears, which pushes PDC up rather than down, so use this to rule the cause in or out.
Verify the denominator and window are unchanged: members with at least two fills in the class and at least 91 days of follow-up, over a stated fixed 12-month window, never a mixture of window lengths.
Write the PDC query so overlapping refills shift the next interval's start to the later of fill_date and the prior interval's end, so a day is covered at most once, and cap at one day per calendar day.

Follow-up

Why is PDC preferred to medication possession ratio when early refills are common?
You want to compare adherent and non-adherent members on hospitalisation. What is wrong with classifying on a 12-month PDC and then following from day zero?
A member switches to a different drug in the same class mid-year. How does your interval logic handle that, and is the class the right grain?

Suggested practice checklist

For a candidate whose interviews will centre on A/B testing, metric movement and causal claims. Design comes before arithmetic, arithmetic before analysis, and the week ends by rehearsing the readout rather than the derivation.

Day 1 — Design one test end to end on paper

Take a single feature change and write the full design: randomization unit, the exact point of exposure, the primary metric with its grain, guardrails, allocation, planned duration, and the decision rule committed before any data exists.
Write why the randomization unit must sit at or above the level where treatment can spill over, and give one case where user-level randomization is still contaminated (shared accounts or devices, or two participants in the same marketplace).
State in advance what you will do if the primary metric is flat while a secondary metric is significant.

Deliverable: A one-page test design with a decision rule written before launch.

Day 2 — Power arithmetic until it is automatic

Compute required sample size per arm for a binary metric with the normal approximation, n is approximately 2 times (z for alpha/2 plus z for power) squared times p(1 minus p) divided by delta squared, for baselines of 2, 10 and 40 percent at a 5 percent relative lift, and note that for a fixed relative lift the requirement falls as the baseline rises because delta grows proportionally with p.
Redo the calculation for a continuous metric using variance in place of p(1 minus p), and show why a heavy-tailed quantity such as revenue per user needs either far more traffic or a capped version with a stated cap.
Convert one of the results into weeks given a weekly eligible traffic figure, then list the two honest ways to shorten it (accept a larger detectable effect, or reduce variance) and write why quietly lowering the power target is a decision to miss more real wins, not a speedup.

Deliverable: A small script or sheet that maps baseline, minimum detectable effect, alpha and power to sample size and weeks, cross-checked against a published calculator.

Day 3 — Variance and the unit-of-analysis problem

Take a ratio metric whose denominator is not the randomization unit (clicks per session, randomized by user) and compute the standard error twice, once naively at session level and once by the delta method or a user-level bootstrap, then record how much the naive version understates it.
Implement CUPED on simulated data: choose a pre-period covariate X measured before assignment, estimate theta as Cov(Y, X) divided by Var(X), and analyse Y minus theta times (X minus its mean) in place of Y. Confirm the variance of the adjusted outcome equals the raw variance multiplied by one minus the squared correlation between Y and X, so a correlation of 0.45 removes about 20 percent of the variance and not 80.
Now run that simulation a few hundred times and confirm the adjusted effect estimate is unbiased for the same effect rather than numerically identical to the raw one. Within any single run the two differ, sometimes by a large fraction of the true effect, because the two arms' pre-period covariate means never coincide exactly in a finite sample; they agree in expectation, which is the property that matters and the one to state out loud.

Deliverable: A notebook showing the adjusted estimator with a measurably smaller variance than the raw one, plus a repeated-simulation table showing the two estimators agreeing on average while differing run by run.

Day 4 — Validity threats you can actually test for

Run a sample ratio mismatch check as a chi-square goodness-of-fit test against the intended allocation, and write the three causes you would chase first (assignment logged before exposure, an arm-specific redirect or load failure, bot filtering applied asymmetrically).
Simulate peeking: generate A/A data, test daily at alpha 0.05 across 14 looks, record the inflated false positive rate, then apply an alpha-spending boundary or commit to a fixed horizon and confirm the rate returns to nominal.
Write how you would separate a novelty effect from a durable lift using the treatment effect plotted against days since first exposure, and what shape would change your recommendation.

Deliverable: One table showing the peeking false positive rate before and after correction, plus a written SRM triage list.

Day 5 — When randomization is not available

Write the identifying assumption for difference-in-differences (parallel trends in the absence of treatment), then plot pre-period trends for two candidate control groups and justify rejecting one of them.
Design a switchback test for a change where user-level randomization would leak across participants, choosing a time-block length against the carryover you expect and saying how you would detect carryover in the data.
List what an interrupted time series or a synthetic control buys you and the one thing neither can rule out: an unobserved shock that coincides with the launch.

Deliverable: A one-page memo recommending a single quasi-experimental design and naming its weakest assumption explicitly.

Day 6 — The readout query

Write the assignment-to-exposure join that returns exactly one row per unit per experiment, and handle units appearing in both arms by excluding and counting them rather than silently keeping one.
Compute the per-arm metric, its variance and the relative lift with a confidence interval in SQL, then reproduce the identical numbers in a notebook as a cross-check.
Add a segment breakdown and write the sentence that keeps it from being p-hacking: segments declared in advance, everything else reported as exploratory and corrected for multiplicity.

Deliverable: A single query that outputs the full readout table, matched to a notebook recomputation.

Day 7 — Present it to someone who will not read the appendix

Give a 10-minute readout of a real or simulated experiment in the order decision, number, uncertainty, caveat.
Have your listener ask "can we ship it" in the case where the primary is flat and a guardrail moved, and answer with a recommendation rather than a request for more data.
Rewrite your opening line so the recommendation lands before any methodology.

Deliverable: A one-page readout whose first line is the recommendation.

Ambiguous requests are the test

Most of the questions in this section reduce to one thing: can you be handed a vague request and come back with something useful? Prepare an example where the ask was underspecified, you chose an interpretation, and you said out loud which interpretation you chose. Describing how you narrowed the question matters more than the technique you eventually used.

Tell me about a project where you had to deal with significant ambiguity.

Medium · behavioural and stakeholder questions

Approach

Close with what you would do differently, concretely.
State the situation in two sentences and spend the rest on your reasoning.
Quantify the outcome, including what you would not claim credit for.

Follow-up

What would you do differently if you ran that project again?
How did you know the outcome was caused by your change?

Explain an incomplete cost series to a non-technical executive

Medium · claims runout · uncertainty · executive communication

An executive opens a dashboard showing risk-adjusted allowed PMPM down 6 percent across the last three incurred months and asks whether the cost initiative is working. You know pharmacy adjudicates within days, professional claims within weeks, and inpatient facility claims over months, so those three months are both undercounted and mix-shifted toward cheap services. There is also a genuine movement of roughly 1.5 percent in the older, complete months. Deliverable: a two-minute spoken answer, the change you make to the chart, and what you commit to telling them and when.

Approach

The probe is whether you can be honest about uncertainty without sounding evasive. Executives read hedging as not knowing, so the answer has to end in a commitment.
Separate the two claims immediately. The 6 percent is an artefact of incomplete data, and there is a smaller real movement in the months that are complete. Delivering only the debunk leaves them holding nothing.
Explain the lag in their terms: the bills for the most expensive care arrive last, so an incomplete month always looks cheap and always looks like it is improving. Keep the phrase completion factor out of the first pass.
Fix the chart instead of explaining around it. Shade or omit the incomplete months, print the paid-through date on the axis, and overlay the same series as it looked at equivalent maturity a year earlier so the shape is comparable rather than merely lower.
Close with a date and a magnitude. Commit to a restated figure once runout matures, say roughly how far you expect the 6 percent to shrink, and name what you would need to see to call the initiative working.

Follow-up

They ask for your best guess today, knowing it is provisional. What do you say?
The restated number comes back at 1 percent. How do you handle having flagged the 6 percent at all?
How do you stop this dashboard producing the same conversation next quarter?

Disagree with a product manager about an adherence nudge

Medium · immortal time · confounding · disagreement

A product manager proposes shipping a refill-reminder feature to the whole member base, citing an internal analysis: members with 12-month proportion of days covered at or above 0.80 had 31 percent fewer admissions than members below it. The roadmap date is three weeks out and engineering is scoped. You believe the comparison builds survival and continuous coverage into the exposure definition, and is separately confounded by the kind of member who refills on time. Deliverable: what you say in the room, what you send afterwards, and the smallest study you would accept as sufficient to ship.

Approach

The probe is whether you can be specific and non-territorial at once. A disagreement that arrives as 'the analysis is flawed' costs you the room; one that names a mechanism and offers a cheaper path keeps it.
Name the two defects separately, because they have different fixes. Classifying a member as adherent over 12 months requires them to stay alive and stay covered for those 12 months, and that guaranteed event-free interval is assigned to the adherent group. Separately, members who refill on schedule differ from those who do not in ways claims never record.
Show rather than assert. Rerun the same comparison as a landmark analysis: classify adherence over days 1 to 90, start follow-up at day 91 for everyone still enrolled and event-free, and report how much of the 31 percent survives.
Separate the association claim from the intervention claim out loud. Nothing in the analysis speaks to whether a reminder changes refill behaviour, which is the actual product question and is separately testable.
Offer the shippable path: a randomised holdout on a subset with proportion of days covered as the primary endpoint, powered on the plausible effect of a reminder rather than on the 31 percent, with a stated read date.

Follow-up

The landmark rerun still shows a 20 percent difference. Do you ship?
The product manager says a holdout delays launch. How do you cost that argument?
What primary endpoint do you choose, and why not admissions?