Senior Manager - Data Mining & Exploratory Intelligence
About The Position
EXL is seeking a seasoned claims-domain subject matter expert for its Concept Research & Exploratory team within the Data Mining Center of Excellence. The role focuses on exploratory claims analysis and supporting the development of advanced data-mining capabilities. The successful candidate will identify claims patterns, anomalies, and potential overpayments across Medicare, Medicaid, and commercial platforms, translating operational expertise into actionable analytics concepts and solutions. The role requires extensive hands-on claims experience and the ability to reverse engineer claims behavior to inform data-driven strategies, tools, and controls. The Senior Manager will work closely with analytics, product, and strategy teams, validate analytical findings against claims and payment realities, and help refine and scale claims monitoring and overpayment detection capabilities.
Requirements
- 10+ years of operations experience, with a strong focus on claims adjudication and payment integrity.
- Extensive experience across Medicare, Medicaid, and/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 and ability to bridge operations and data science.
- Experience collaborating with cross-functional teams, including analytics, product, strategy, and compliance.
- Excellent communication skills and 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.
Responsibilities
- Lead exploratory analysis of claims data to identify utilization patterns, anomalies, and potentially overpaid or inappropriate claims.
- Apply knowledge of billing rules, coding, reimbursement, and workflows to guide data-mining and investigative efforts.
- Reverse engineer 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 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.
- Communicate insights, risks, and opportunities to technical and non-technical stakeholders.
- Support the ongoing refinement and scaling of claims monitoring and overpayment detection capabilities.
Benefits
- Benefits are referenced at the employer's US careers and benefits webpage; specific benefits are not listed in the posting.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
