Senior Manager - Data Mining & Exploratory Intelligence

Sr Manager– Data Mining & Exploratory Intelligence

Role Overview
We are seeking a seasoned Claims Domain subject matter Expert in our CRE – Concept research & exploratory team within our Datamining COE for exploratory claims analysis and support the development of advanced data mining capabilities. This role will focus on identifying claims patterns, anomalies, and potential overpayments across Medicare, Medicaid and commercial platforms, 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.

Key Responsibilities
• Lead exploratory analysis of claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
• Apply deep knowledge of billing rules, coding, reimbursement, and workflows to guide data mining and investigative...