Senior Data Mining Auditor

Job Summary

A company is looking for a Senior Data Mining Auditor to identify medical cost savings for healthcare insurance clients through data mining strategies.

Key Responsibilities

• Support the Payment Integrity team with operational reports and dashboards development
• Produce detailed data mining reports and extract critical information from data sets
• Develop quality control processes and create algorithms to flag suspect claims

Required Qualifications

• Seven years of medical claims investigation or data mining experience, with five years in a leadership role
• Relevant medical billing and coding certification and a bachelor's degree are highly preferred
• Minimum high school diploma or GED
• Experience with MS SQL Server, Power BI, and medical claim reimbursement structures
• Proficiency in medical terminology and familiarity with healthcare regulations