EXL

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Manager – Data Mining, Exploratory Intelligence (Behavioral Health)

ManagerManagerFull TimeRemoteTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

38 days ago

Salary

Not specified

Bachelor Degree10 yrs expEnglish

Job Description

• Lead exploratory analysis of behavioral health claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims • Apply deep knowledge of BH billing rules, coding, 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

Job Requirements

  • 10+ years of experience in operations with a strong focus on claims adjudication and payment Integrity
  • Extensive experience across Medicare, Medicaid or commercial platforms
  • 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, SIU, or recovery initiatives
  • Experience supporting or designing claims analytics or data mining programs
  • Familiarity with common BH coding schemes, authorization models, and provider billing behaviors

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development

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