Sr Manager– Data Mining & Exploratory Intelligence
About the Role
We are seeking a Claims Domain subject matter Expert in our CRE – Concept research & exploratory team within our Datamining COE for exploratory claims analysis and support the development of advanced data mining capabilities.
Full Job Posting
Responsibilities
- Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
- Apply deep knowledge of CMS rules, contract interpretation, reimbursement, and workflows to guide data mining and investigative efforts
- Perform reverse engineering of claims outcomes to understand root causes of payment issues and system behaviors
- Translate operational and claims insights into clear use cases, concepts, and solution ideas for analytics and product teams
- Partner closely with analytics, product, and strategy teams to ensure solutions align with real-world claims operations
- Validate data-driven findings against practical claims and payment realities
- Clearly communicate insights, risks, and opportunities to both technical and non-technical stakeholders
- Support ongoing refinement and scaling of claims monitoring and overpayment detection capabilities
- Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims • Apply deep knowledge of CMS rules, contract interpretation, reimbursement, and workflows to guide data mining and investigative efforts • Perform reverse engineering of claims outcomes to understand root causes of payment issues and system behaviors • Translate operational and claims insights into clear use cases, concepts, and solution ideas for analytics and product teams • Partner closely with analytics, product, and strategy teams to ensure solutions align with real-world claims operations • Validate data-driven findings against practical claims and payment realities • Clearly communicate insights, risks, and opportunities to both technical and non-technical stakeholders • Support ongoing refinement and scaling of claims monitoring and overpayment detection capabilities
Qualifications
- 10+ years of experience in US Healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity
About EXL
EXL is a global data and AI company that provides analytics, digital operations, and industry-specific services to enterprises in insurance, healthcare, banking, retail, media, and energy.
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