Data Mining Content Ideation Project Management

Gainwell Technologies LLC

2d

About The Position

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.SummaryAs a Data Mining Content Ideation Project Management, you will provide strategic and technical leadership in designing, implementing, and scaling advanced data mining and AI-enabled analytics solutions that identify improper payments and improve claims accuracy across medical, dental, and pharmacy domains.
This role blends deep healthcare payment integrity expertise, advanced data mining and AI capabilities, and principal-level delivery leadership. You will translate complex State, Federal, and client-specific reimbursement policies into scalable analytics, guide cross-functional teams through complex implementations, and ensure successful delivery of high-impact payment integrity solutions for Gainwell clients.
You will act as a content authority, product owner, and delivery leader, partnering with engineering, clinical, operations, and client teams to safeguard healthcare resources for vulnerable populations.Your role in our mission

Requirements

• 7+ years of Healthcare Payment Integrity, Data Mining, or Advanced Analytics experience.
• Demonstrated experience in healthcare payment integrity data mining, including validation of claims data accuracy and payment accuracy.
• Proven experience applying CMS regulations, State/Federal guidelines, coding standards, and reimbursement policies to claims analytics.
• Strong experience translating business and policy requirements into technical and analytical solutions.
• Hands-on experience with AI/ML-driven analytics, such as predictive modeling, anomaly detection, pattern recognition, or NLP applied to healthcare or financial data.
• Ability to articulate AI-driven insights clearly to technical and non-technical stakeholders.

Responsibilities

• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives within the Systems Integration group.
• Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments across medical, dental, and pharmacy claims.
• Support and lead responses to client RFPs, contributing superior written content related to data mining, AI, and payment integrity capabilities.
• Translate complex healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules.
• Research and apply CMS regulations, State and Federal guidelines, coding standards, and industry best practices to claims data and payment integrity initiatives.
• Lead the incorporation of AI, machine learning, and advanced analytics techniques (e.g., anomaly detection, predictive modeling, NLP, pattern recognition) into payment integrity solutions.
• Partner with data science and engineering teams to ensure AI solutions are explainable, auditable, compliant, and operationally scalable.
• Ensure AI-driven solutions align with regulatory requirements, client policies, and ethical AI standards.
• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives.
• Serve as a senior mentor and subject matter expert, guiding and developing analysts, content designers, and project team members.
• Partner with clinical, operations, appeals, validation, and client services teams to resolve production issues and support ongoing audits.
• Drive continuous improvement of audit processes, analytics, and delivery methodologies.

Benefits

• generous, flexible vacation policy
• educational assistance
• 401(k) employer match
• comprehensive health benefits
• leadership and technical development academies

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees