Senior Manager – Data Mining, Exploratory Intelligence

EXL

. Lead exploratory analysis of claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims .

Posted 11/4/2026full-timeRemote • United StatesSenior💰 $93,900 - $154,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in claims adjudication and payment integrity, with a strong analytical mindset to identify patterns and anomalies in large claims datasets. Effectively communicates insights and collaborates with cross-functional teams to enhance claims monitoring and overpayment detection capabilities.

Highest-signal resume keywords

Claims AdjudicationPayment IntegrityData MiningClaims AnalyticsCross-Functional Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewAuditingPattern RecognitionData AnalysisRoot Cause AnalysisCoding KnowledgeBilling RulesReimbursement ProcessesUtilization AnalysisOverpayment Detection

Soft Skills

Excellent CommunicationAnalytical MindsetProblem-SolvingStakeholder EngagementCollaboration

Industry Keywords

MedicareMedicaidCommercial PlatformsSIURecovery InitiativesAuthorization ModelsProvider Billing Behaviors

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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
Bachelor's Degree