Senior Manager– Data Mining & Exploratory Intelligence
Hyderabad, Telangana, India
- Pay
- Pay not listed
- Work setting
Hybrid — work setting source
Work setup in the employer’s posting: Hybrid
From the employer’s posting- Employment
Full-time — employment source
Employment type in the employer’s posting: Full time
From the employer’s posting
What you’ll work on
Full postingLead exploratory analysis of claims paid data for utilization patterns, anomalies and overpayments
Reverse engineer claims outcomes to find root causes of payment issues
Turn operational and claims insights into use cases and solution ideas for analytics and product teams
Apply CMS rules and contract knowledge to guide data mining and investigations
Validate data-driven findings against practical claims and payment realities
From the employer’s posting
Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
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
Apply deep knowledge of CMS rules, contract interpretation, reimbursement, and workflows to guide data mining and investigative efforts
Validate data-driven findings against practical claims and payment realities
Posting record
Report an error- Status in our records
- Live
- First seen by us
- Oct 3, 2026 · 26 days ago
- Recorded sightings
- 181
- Last seen by us
- Oct 29, 2026
- Employer says posted
- Sep 30, 2026
These dates show when we found the posting. Check the employer’s website to confirm it is still accepting applications.
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Job description
This role will focus on identifying claims patterns, anomalies, and potential overpayments across Medicare, Medicaid and commercial business, while translating deep operational insight into actionable analytics concepts and solutions.
The ideal candidate brings extensive hands-on claims experience and can “reverse engineer” claims behavior to inform data-driven strategies, tools, and controls.
• Extensive experience across Medicare, Medicaid or commercial business
• 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 Data Mining or recovery initiatives
• Experience supporting or designing claims analytics or data mining non-clinical programs
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
• 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
10+ years of experience in US Healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity
Source details
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- Pay
No pay amount identified in the saved description.
- Location & working pattern
Hyderabad, Telangana, India
Working pattern and location restrictions need checking in the full posting.
- Work authorization
No clear work-authorization passage found. Eligibility is unconfirmed.
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