Senior Auditor Data Mining
Job Summary
To support the Payment Integrity team, the full-time Senior Auditor Data Mining will identify healthcare cost-saving opportunities through advanced data mining strategies, claims analysis, and audit development while working remotely.
Key Responsibilities
- Develop and implement data mining strategies to identify claims overpayments and cost-saving opportunities
- Create and deploy payment integrity edits and auditing methodologies to flag suspect claims
- Produce detailed data mining reports and analyses to support operational decisions
Required Qualifications
- Minimum high school diploma or GED required
- Seven or more years of healthcare claims investigation or data mining experience
- Five or more years of leadership experience in healthcare auditing or payment integrity
- Demonstrated expertise in healthcare claims processing and reimbursement methodologies
- Advanced proficiency with Microsoft Excel and ability to utilize SQL Server and Power BI
Complete Job Description
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