Manager– Data Mining & Exploratory Intelligence
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What you'll do
- Conduct 360-degree claims review, auditing, and payment integrity
- Identify patterns, anomalies, and inappropriate payments within large claims datasets
- Bridge operations and data science using a strong analytical mindset
- Collaborate with cross-functional teams including analytics, product, strategy, and compliance
- Communicate and explain complex claims concepts clearly
- Lead or participate in payment integrity data mining or recovery initiatives
- Support or design claims analytics or data mining non-clinical programs
What they're looking for
- 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
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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
Company
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