Senior Director, Data Mining

Gainwell Technologies LLC • OH

120d • $137,100 - $195,800

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. We are seeking a strategic and experienced leader for the role of Senior Director, Data Mining, responsible for overseeing ideation and validation of healthcare payment integrity data mining. This leader will manage a high-performing team to identify, test, and validate concepts that detect improper healthcare payments. The ideal candidate brings deep healthcare analytics expertise and a proven ability to lead teams, drive measurable results, and collaborate cross-functionally in a dynamic environment.

Requirements

• Bachelor’s degree required (Healthcare Administration, Data Science, Business, or related).
• Minimum of 10 years of experience in healthcare payment integrity data mining with at least 5 years in a leadership role.
• Strong understanding of healthcare claims data, coding systems (ICD, CPT, DRG), and payment methodologies.
• Demonstrated success in managing ideation and validation processes that produce measurable financial returns.
• Skilled in SQL, Excel, and visualization/reporting tools; experience with SAS, Python, or similar tools preferred.
• Excellent communication and presentation skills; ability to influence cross-functional stakeholders and executives.
• Experience working in or with payer or provider organizations, government healthcare programs, or audit vendors.
• Experience integrating AI/ML into data mining operations.

Responsibilities

• Provide strategic direction and day-to-day leadership for the data mining team focused on uncovering and confirming data-driven audit opportunities.
• Oversee the full data mining lifecycle from opportunity identification and concept design through validation, deployment, and post-audit analysis.
• Apply knowledge of provider billing practices, claim adjudication processes, and regulatory requirements to guide development of actionable audit concepts.
• Establish and track performance metrics to ensure teams meet productivity, quality, and financial objectives.
• Collaborate with IT, Product and Client Services teams to refine, test, and operationalize audit concepts.
• Lead documentation, knowledge sharing, and root cause analysis to inform ongoing audit development and provider education.
• Mentor and develop managers and analysts to support succession planning and skill development across the team.
• Represent the function in client meetings and executive-level discussions to articulate value, methodology, and results.

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees