Manager– Data Mining & Exploratory Intelligence
At a glance
Manager-level Data Analysis & BI role at Fa Ewjt Saasfaprod1. Hyderabad · full-time.
Pay not stated Data Analysis & BI salary
dataroles summary, based on the employer's posting.
What you'll do
- Examine paid claims for utilization patterns, irregularities and claims that may have been paid incorrectly
- Use CMS guidance, contract terms, reimbursement knowledge and workflow details to steer data mining investigations
- Work backward from claim outcomes to find causes of payment issues and understand system behavior
- Convert operational claims insights into practical concepts for analytics and product groups to assess
- Check findings against claims realities, then explain risks and opportunities to technical and non-technical audiences
What you bring
- At least seven years in US healthcare claims, with a focus on adjudication and payment-integrity data mining
- You have worked across Medicare, Medicaid or commercial claims and understand review, auditing and payment integrity
- You can identify anomalies in large claims datasets and connect operational work with data science
Who this fits
This manager-level role suits someone who can guide claims investigations and collaborate with analytics, product and strategy teams. The position is hybrid in Hyderabad, India.
From the employer
Extensive experience across Medicare, Medicaid or commercial business
• Demonstrated expertise in 360-degree claims review, auditing, and payment integrity
• Proven ability to identify patterns, anomalies, and inappropriate payments within large claims datasets
• Strong analytical mindset with the ability to bridge operations and data science
• Experience collaborating with cross-functional teams (analytics, product, strategy, compliance)
• Excellent communication skills with the ability to explain complex claims concepts clearly
• Prior involvement in payment integrity data mining or recovery initiatives
• Experience supporting or designing claims analytics or data mining non-clinical programs
Key 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
Required Qualifications
• 7+ years of experience in US healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity
Data Analysis & BI work from LinkedIn, X, Reddit and Upwork, in one list.
Each morning you get everything that fits, strongest first.
Data Analysis & BI
Find me workBy the team behind dataroles.