Senior Data Mining Manager
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Job Summary
Leading exploratory analysis of claims data, the remote Senior Data Mining Manager will identify utilization patterns, anomalies, and potential overpayments while translating operational insights into actionable analytics solutions.
Key responsibilities
- Lead exploratory analysis of claims data to identify utilization patterns and potential overpaid claims
- Apply knowledge of billing rules and workflows to guide data mining and investigative efforts
- Translate operational insights into clear use cases and collaborate with analytics and product teams
Required qualifications
- 10+ years of experience in operations focused on claims adjudication and payment integrity
- Extensive experience with Medicare, Medicaid, and commercial platforms
- Demonstrated expertise in claims review, auditing, and identifying payment anomalies
- Strong analytical mindset with experience in bridging operations and data science
- Prior involvement in payment integrity or claims analytics initiatives
Complete Job Description
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