Job Closed

This listing is no longer active.

EXL logo
EXL

We make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay

Senior Manager – Data Mining, Exploratory Intelligence

ManagerManagerOtherRemoteSeniorTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

114 days ago

Salary

0

Seniority

Senior

Bachelor Degree10 yrs expEnglish

Job Description

Senior Manager – Data Mining, Exploratory Intelligence

EXL

• 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

Job 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

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development

Related Categories

Related Job Pages

More Manager Jobs

Frasco, Inc. logo

Senior Project & Portfolio Manager

Frasco, Inc.

Decide Without Doubt: Unveiling the Truth through Comprehensive Investigations

Manager114 days ago
OtherRemoteTeam 201-500H1B No Sponsor

• Lead cross-functional projects from intake through delivery, following established project management standards • Build and maintain project schedules, milestones, risks, and dependencies • Facilitate project ceremonies, including kickoffs, working sessions, status updates, and retrospectives • Identify and escalate risks, issues, and resource constraints with clear recommendations • Track dependencies and sequencing across initiatives, including management tools, templates, and workflows • Provide support to teams in adopting new processes through training, documentation, and hands-on guidance • Serve as a key point of coordination across project teams • Support organizational readiness through communication, documentation, and alignment • Build strong relationships across teams to drive effective execution and shared accountability

California
$95K - $115K / year
Job Closed
Manhattan Associates logo

Technical Manager

Manhattan Associates

Supply chain & Omnichannel commerce starts here.

Manager114 days ago
OtherRemoteTeam 1,001-5,000Since 1990H1B Sponsor

• Lead and manage the efforts of multi-disciplined personnel teams (Engineers and DBAs) to deliver systems within guidelines for schedule, cost and quality. • Mentor software engineers on the software development process and engineering practices. • Provide the technical direction and leadership of the technical architecture and database design within web based software products. • Monitor and report development status on a very regular basis and implement remedial actions as appropriate. • Participate at all levels of software development lifecycle such as iterative or agile software methods. • Manage the development of .Net based web applications using C#.Net, MVC 5.0, jQuery, ASP.NET, Web Api2.0, SSIS, SSRS, report model and .NET service design patterns. • Lead the creation and enforcement of designs, programming and testing standards. • Review unit test plans and perform code reviews. • Participate in functional and technical reviews. • Work decomposition, scheduling and estimation.

United States
Job Closed
Prisma Health logo

Manager, ITS, Revenue Cycle Systems, Billing

Prisma Health

Our Purpose: Inspire health. Serve with compassion. Be the difference.

Manager114 days ago
OtherRemoteTeam 10,001+H1B Sponsor

• Executes and provides leadership to teams for operational and strategic planning related to revenue cycle systems, including business requirements, project planning, budgeting, performance optimization, and resource allocation. • Ensures revenue cycle ITS resources and initiatives are aligned with organizational strategic objectives and regulatory requirements. • Leads operational and strategic planning for revenue cycle systems, including budgeting, forecasting, and resource management. • Ensures revenue cycle ITS initiatives support organizational goals and compliance standards. • Participates in and supports ITS governance committees focused on revenue cycle systems. • Collaborates with operational leaders to identify and analyze areas for improvement, ensuring alignment with business processes and strategic vision. • Key decision-maker for complex issues involving revenue cycle systems and workflows. • Partners with ITS and operational departments to define system requirements and implement solutions that enhance efficiency and customer service. • Develops and executes plans for financial systems strategy in coordination with leadership and governance structures. • Prepares and manages the annual operating budget for revenue cycle systems. • Builds and maintains vendor relationships to optimize pricing, service quality, and system performance. • Ensures compliance with industry standards, data security, and privacy regulations. • Performs other duties as assigned.

South Carolina
Job Closed
Affirm logo

Senior Manager, Accounts Management

Affirm

Affirm is a financial services company that is on a mission to provide its customers with “honest financial products that improve lives.” As an employer, Affirm maintains a rem

Manager114 days ago

• You will own and lead Affirm’s largest relationships with our international partners to build connections, drive growth and oversee long-term strategy across multiple business units. • You will be responsible for defining and driving the strategic vision for the partnership, aligning joint priorities with Affirm’s broader goals, and influencing senior stakeholders on both sides. • You will develop and execute multi-year growth roadmaps, including product integrations, co-marketing strategies, and go-to-market expansions that drive significant GMV, revenue, and user acquisition. • You will analyze partner performance and recommend programs to increase product adoption, grow awareness and visibility, and sell into expansion opportunities. • You will orchestrate cross-functional teams across our Product, Technical, Credit, Analytics, Marketing, and Risk teams to execute partnership initiatives and drive business results. • Manage customer health to ensure overall customer satisfaction and business results

United Kingdom
£98K - £138K / year