Job Closed

This listing is no longer active.

EXL logo
EXL

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

Manager – Data Mining, Exploratory Intelligence (Behavioral Health)

ManagerManagerOtherRemoteLeadTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

121 days ago

Salary

0

Seniority

Lead

Bachelor Degree10 yrs expEnglish

Job Description

Manager – Data Mining, Exploratory Intelligence (Behavioral Health)

EXL

• Lead exploratory analysis of behavioral health claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims • Apply deep knowledge of BH 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 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 BH 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

XPEL logo

Installation Manager

XPEL

Paint Protection Film | Window Tint | Solar & Security Film | Ceramic Coatings

Manager122 days ago
Full TimeRemoteTeam 201-500Since 2014H1B Sponsor

• Oversee daily operation of the Installation facility including full P&L responsibility • Manage and develop team of installers • Acquire, retain and manage product sales with Independent Installers and Dealerships • Meet or exceed both revenue and gross profit objectives outlined by management, while maintaining competitive pricing in the marketplace • Responsible for keeping current clients satisfied and delivering exceptional client service • Monitor and analyze customer’s usage of our product; introducing new products • Be the primary point of contact and build long-term relationships with customers • Perform individual market analyses within the territory to develop new customer and conquest strategies • Follow up on sales leads • Help customers through email, phone, and in person meetings • Responsible for working with the sales administration team to onboard and integrate new clients and developing existing client relationships

Japan
athenahealth logo

Talent and Culture Senior Manager

athenahealth

We provide network-enabled services, mobile apps, and data-driven insights to hospitals and medical organizations.

Manager122 days ago
OtherRemoteTeam 5,001-10,000Since 1997H1B Sponsor

• Design and implement organization-wide talent development strategies that build future-focused capabilities aligned with business goals • Lead performance management, leadership development and succession planning that enable organizational growth • Lead initiatives that enhance talent identification, retention and growth • Strengthen established talent programs while identifying opportunities for innovation and improvement • Design development solutions that address current skill gaps and anticipate future workforce needs • Integrate emerging technologies including AI tools into talent workflows to enhance efficiency, inform strategy and improve decision making • Partner with business leaders to influence and support organizational change through strategic planning, impact assessment, and stakeholder engagement • Develop change management plans and internal campaigns that drive adoption of talent practices • Support the integration of new HR technologies and tools to enhance talent management processes • Participate in special projects and initiatives that support broader HR and business objectives • Monitor industry trends and best practices to ensure athenahealth remains competitive in talent management and AI utilization • Support diversity, equity, and inclusion efforts through talent and culture initiatives.

Maine + 3 moreAll locations: Maine | Massachusetts | Texas | Vermont
$101K - $171K / year
Job Closed

Role Description The Customer Manager is a salesperson responsible for being the sales expert for a designated Customer(s), providing strategic customer insights. The Customer Manager works to ensure joint business plans are executed by the customer. This role works closely with Key Account Managers (KAMs) within that assigned department, as well as order entry, claims, schematics, and retail sales associates to ensure all Client and Customer standards are met. The Customer Manager (CM) must possess the ability to bridge the relationship between the Key Account Management Team (KAM Team) and all stakeholders at assigned customer(s). This teammate will collaborate with customers to develop strategic plans to accomplish the business goals and work with retailer associates (such as buyers, category managers, replenishment managers, and others) on Headquarter calls to implement the programs. Essential Responsibilities - Drive our clients’ business at assigned customer. Increase distribution, grow sales dollars/units/share/other KPI’s, while staying within budget guidelines. - Manage and coordinate Sales Activities, through sales analysis of customer data, sales planning, and sales presentation. - Conduit between Customer(s), Key Account Managers and Clients through product line presentations, new item presentations, display selling. - Manage and delegate KAM and Client Divisional Initiatives (i.e. achieving parity pricing vs. inline and competition, maintain up to date Team Business Trackers, photo request presentation, and special requests). - Secure/ensure timely and accurate responses from customer(s) to KAM Team/Clients which includes promotion forecast. - Manage selling recommendations from the customer(s) to grow and build the business long-term. - Attend and present in client meetings at designated customer(s). - Attend and present in Management Team meetings. - Conduct and manage customer(s) meetings focusing on client promotional events, displays, etc. - Build relationships with buyers and support departments at customer, works with KAM to recommend growth plans, execute plans, assist with tactical issues such as PO’s, cost changes, contract execution and ensuring retail/merchandising execution. - Develop and leverage relationships with key influencers and decision makers in assigned customers. - Sell displays, period promotions, present business reviews, and new item introductions. - Build and present product distributions based on previous performance using the customer scan data. - Present pricing disparities in assigned customer based on client recommendations; achieve parity pricing inline and vs. competition. - Take weekly photos based on client request and needs. - Acquire weekly pricing for clients based on their product(s). Client Quota Achievement - Meets or exceeds Client’s goals for sales, distribution, share, pricing, shelving, and promotional volume. - Launches strategies to pursue new opportunities. Client KPI’s Achievement - Implements retailer headquarter calls and penetrate key positions at the retailer to achieve sales goals by managing and maximizing manufacturer marketing and promotional funds while staying within financial guidelines. - Ensure that all retail pricing and indirect order guides within the division is updated by regularly correcting discrepancies. - Secure Client approved schematics for all Clients’ brands by providing direction and communication to our schematic, reset, and retail departments. - Ensure incremental sales through distribution of new products and maintenance of existing SKU’s. - Collaborate with category management team to develop retailer presentations by using database rationale such as SKU optimization, efficient promotion causal data, and lift analysis. - Manage accounts to achieve the targeted ACV on Innovation. Business / Category Reviews - Builds and maintains effective client and retailer relationships in order to ensure customer access and client perspective that we are connected and engaged with key stakeholders. - Demonstrates sales accomplishments and areas of opportunity by developing sales presentations for Customers and Clients. - Implements Customer HQ Calls and demonstrates an ability to penetrate key positions at the retailer. - Offers strategic input pursuant to annual business plans, problem solving, ongoing customer management. Finds the intersection of retailer and client objectives and drive win/win scenarios. Supervisory Responsibilities - This position does not have supervisory responsibilities for direct reports. - May delegate work of others and provide guidance, direction and mentoring to indirect reports. Minimum Qualifications - Education Level: (Required): Bachelor's Degree or equivalent experience. - 2-4 years in sales or retail experience and knowledge of CPG industry. - Experience managing multiple projects simultaneously. - Knowledge and experience with designated customers preferred. Skills, Knowledge and Abilities - Excellent written communication and verbal communication skills. - Ability to motivate and inspire. - Good interpersonal skills. - Demonstrate conflict management skills. - Excellent decision-making skills. - Ability to exercise sound judgment. - Ability to work effectively with management. - Ability to ensure a high level of service and quality is maintained. - Strong computer skills including proficiency with Microsoft Word, Excel, PowerPoint, Access, Outlook, and web-browsers. Environmental & Physical Requirements - Office / Sedentary Requirements: Incumbent must be able to perform the essential functions of the job. Work is performed primarily in an office environment. - Typically, requires the ability to sit for extended periods of time (66%+ each day), ability to hear telephone, ability to enter data on a computer and may require the ability to lift up to 10lbs.

United States
Job Closed
CVS Health logo

Manager, Behavioral Health Care Management – BH, RN

CVS Health

Bringing our heart to every moment of your health.

Manager122 days ago
OtherRemoteTeam 10,001+Since 1963H1B No Sponsor

• Accountable for the day-to-day management of assigned care management teams for appropriate implementation and adherence with established practices, policies and procedures • Participates in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills • Develops, initiates, monitors and communicates performance expectations • Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams • Supports the management of complex physical and behavioral health cases by being clinically and culturally competent with appropriate training and experience • Utilizes critical thinking and judgment to collaborate and inform the care management process in order to facilitate appropriate healthcare outcomes for members • Ensures access to primary care, behavioral health, and coordination of health care services for members as needed • Provides clinical leadership and assists care management staff in supporting members’ understanding of service recommendations based on member need • Conducts regularly scheduled individual and team meetings with a focus on member service delivery, completion of administrative duties, and meeting established productivity standards • Using a holistic approach consults with care managers, medical directors, system of care, social support teams and/or other market staff to overcome barriers to meeting goals and objectives • Identifies and escalates quality of care issues through established channels • Conducts all administrative duties in accordance with established standards for supporting and managing a team • Communicates strategic plan and specific tactics to meet plan needs and ensures implementation of tactics to meet strategic direction for cost and quality outcomes • Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes • Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format • Accountable for meeting the clinical operational and quality objectives of the unit • Consistently demonstrates the ability to serve as a model change agent and lead change efforts • Accountable for maintaining compliance with policies and procedures and implements them at the employee level • Develops and implements processes and resources for providing support to members who opt out of care coordination • Ensures care management/care coordination and disease management are part of population health and quality improvement activities • Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes

Oklahoma
$78.3K - $168.7K / year
Job Closed