Senior Manager - Data Mining & Exploratory Intelligence
At a glance
Senior Data Analysis & BI role at Fa Ewjt Saasfaprod1. United States · full-time · $93,900–$154,200 base.
dataroles summary, based on the employer's posting.
What you'll do
- Examine claims data to spot utilization trends, unusual activity and possible overpayments across Medicare, Medicaid or commercial platforms
- Use billing, coding, reimbursement and workflow knowledge to guide investigations and explain payment issues
- Turn claims operations findings into analytics concepts and use cases for product and analytics teams
- Check analytical findings against real claims and payment practices, then share risks and insights with varied audiences
- Help improve and expand claims monitoring and overpayment detection capabilities
What you bring
- At least ten years in operations, with substantial work in claims adjudication and payment integrity
- Hands-on experience with Medicare, Medicaid or commercial claims, including full-cycle review, auditing and payment integrity
- A record of finding suspicious patterns and inappropriate payments in large claims datasets
- Experience contributing to payment integrity, SIU or recovery work, or to claims analytics and data-mining programs
Who this fits
This senior role suits someone who can connect detailed claims operations knowledge with analytics and explain complex findings to technical and non-technical partners. You'll work across analytics, product and strategy teams.
From the employer
We are seeking a seasoned 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. This role will focus on identifying claims patterns, anomalies, and potential overpayments across Medicare, Medicaid and commercial platforms, while translating deep operational insight into actionable analytics concepts and solutions.
The ideal candidate brings extensive hands-on claims experience and can “reverse engineer” claims behavior to inform data-driven strategies, tools, and controls.
*Base Pay Range: $93,900- $154,200
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
• Lead exploratory analysis of claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
• Apply deep knowledge of billing rules, coding, 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
• 10+ years of experience in operations with a strong focus on claims adjudication and payment Integrity
• Extensive experience across Medicare, Medicaid or/ and commercial platforms
• 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, SIU, or recovery initiatives
• Experience supporting or designing claims analytics or data mining programs
• Familiarity with common coding schemes, authorization models, and provider billing behaviors
*The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.
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