Sr Manager– Data Mining & Exploratory Intelligence
At a glance
Senior 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
- Analyze paid claims to surface utilization trends, unusual activity and potential overpayments
- Use CMS rules, contract terms, reimbursement knowledge and workflows to guide claim investigations
- Trace claim outcomes back to causes, including payment problems and system behavior
- Turn operational findings into use cases and solution ideas, then validate them against claims realities
- Work with analytics, product and strategy teams to improve claims monitoring and overpayment detection
What you bring
- At least ten years working with US healthcare claims, focused on adjudication and payment integrity data mining
- Hands-on experience reviewing and auditing claims across Medicare, Medicaid or commercial business
- A record of finding anomalies and inappropriate payments in large claims datasets
Who this fits
This senior role suits someone who can connect detailed claims operations with analytics and explain complex findings to technical and non-technical audiences. The position is based in Hyderabad and follows a hybrid arrangement.
From the employer
This role will focus on identifying claims patterns, anomalies, and potential overpayments across Medicare, Medicaid and commercial business, 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.
• 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
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
10+ years of experience in US Healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity
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