Manager– Data Mining & Exploratory Intelligence

About the role

Proven ability to identify patterns, anomalies, and inappropriate payments within large claims datasets Experience collaborating with cross-functional teams (analytics, product, strategy, compliance) Prior involvement in payment integrity data mining or recovery initiatives Experience supporting or designing claims analytics or data mining non-clinical programs

What you'll do

• Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
• Apply deep knowledge of CMS rules, contract interpretation, 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

What you need

• Claims processing
• Audit
• Product strategy
• Compliance