LogoFresh Jobs Ahead
EXL
EXL
Skilled Worker Visa SponsorHealthcareInsuranceLogistics
EXL is a business consulting and services company that helps organizations use data, analytics, and technology to improve operations and make better decisions. Its work includes operations management, decision analytics, and digital transformation, with experience supporting clients in healthcare, insurance, finance, and logistics. EXL combines data science with practical business expertise to develop solutions tailored to each organization’s goals, operating model, and industry context.
LinkedIn
Company Jobs

Senior Manager, Claims Data Mining and Payment Integrity

Lead claims analytics and exploratory data mining to detect Medicare, Medicaid, and commercial overpayments. Turn payment-integrity expertise into practical solutions for analytics and product teams.

INIndiaHybridFull-timeSeniorEnglish RequiredData Scientist

Description

  • Lead exploratory analysis of paid claims data to uncover utilization patterns, anomalies, and potentially inappropriate or excessive payments
  • Apply expertise in CMS regulations, contract interpretation, reimbursement, and claims workflows to direct data-mining and investigative work
  • Reverse-engineer claims outcomes to identify the root causes of payment issues and system behavior
  • Convert operational and claims findings into actionable use cases and solution concepts for analytics and product teams
  • Work with analytics, product, and strategy partners to align solutions with real-world claims operations
  • Assess analytical findings against practical claims and payment conditions
  • Present insights, risks, and opportunities clearly to technical and non-technical audiences
  • Help improve and scale claims monitoring and overpayment-detection capabilities

Requirements

  • At least 10 years of U.S. healthcare claims experience, with a strong focus on adjudication and payment-integrity data mining
  • Broad experience working with Medicare, Medicaid, or commercial healthcare business
  • Established expertise in end-to-end claims review, auditing, and payment integrity
  • Ability to detect patterns, anomalies, and inappropriate payments in large claims datasets
  • Strong analytical judgment and the ability to connect operational expertise with data science
  • Experience working across analytics, product, strategy, and compliance functions
  • Excellent communication skills for explaining complex claims concepts to varied audiences
  • Previous participation in payment-integrity data-mining or recovery initiatives
  • Experience supporting or developing non-clinical claims analytics or data-mining programs
  • Deep understanding of CMS rules, contract interpretation, reimbursement, and claims workflows

Related Jobs

General Dynamics Information Technology

VMware Engineer with TS/SCI and Polygraph Clearance

General Dynamics Information Technology
H1B Visa SponsorConsultingHealthcareLogistics
USUnited StatesMDMarylandVAVirginia
$153,000 – $207,000 / year
On-siteFull-timeMiddleSeniorEnglish RequiredEngineer
TypeScriptVMware

Designs and operates secure VMware virtualization environments for General Dynamics Information Technology’s U.S. government customers. This full-time onsite role supports vSphere infrastructure, systems engineering, automation, and operations in Maryland or Virginia.

Open