oracle

Manager– Data Mining & Exploratory Intelligence

EXL Service

Hyderabad, IND

Full-time

Senior · 7+ years experience

Hybrid

Discovered 1 weeks ago

Free

Job Fit Check

Base Career helps you apply smarter for this job.

Ready to Scan

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

7+ years of experience in US healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity

Skip the repetitive application forms

Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.

Trusted by over 500,000 job seekers on Base Career