Senior Manager – Data Mining, Exploratory Intelligence

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $93.9k - $154.2k / year

⏰ Full Time

🟠 Senior

📊 Data Scientist

👻 Ghost score 2%

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• 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

🎯 Requirements

• 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 • Bachelor's Degree

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