Datamining - Exploratory Claims Analyst - 9+ Years - Hyderabad

Crescendo Global Leadership Hiring India; Hyderabad; On-site; INR 2,500,000 - 4,200,000; Full time

Job summary

Ccrescendo Global is seeking a seasoned US Healthcare Claims professional to join its Data Mining Centre of Excellence in Hyderabad, focusing on identifying patterns, anomalies and overpayments across Medicare, Medicaid and Commercial healthcare businesses.

You will work with analytics, product and strategy teams to translate claims expertise into data-driven solutions, bridging operations with analytics and delivering actionable insights.

Qualifications

• 7+ years of experience in US Healthcare Claims.
• Extensive experience in Medicare, Medicaid and/or Commercial healthcare claims.
• Hands-on experience in Payment Integrity, Claims Auditing, Overpayment Identification or Recovery.
• Experience identifying claims patterns, anomalies and inappropriate payments within large claims datasets.
• Exposure to claims analytics, data mining or payment integrity data-mining initiatives.
• Strong understanding of CMS rules, reimbursement, contract interpretation and claims workflows.
• Ability to bridge claims operations with analytics and data-driven solutions.
• Excellent communication skills with the ability to explain complex claims concepts to technical and non-technical stakeholders.

Responsibilities

• Lead exploratory analysis of claims data to identify utilization patterns, anomalies, overpayments and inappropriate payments.
• Apply knowledge of CMS rules, reimbursement, contracts and claims workflows to guide investigations.
• Perform 360-degree claims reviews and identify root causes of payment issues.
• Translate claims and operational insights into data-mining use cases for analytics and product teams.
• Partner with cross-functional teams and validate findings against real-world claims and payment processes.

Skills

US Healthcare Claims

Medicare/Medicaid/Commercial claims

Payment Integrity

Data mining

CMS rules & workflows

Communication skills

Job description

Datamining - Exploratory Claims Analyst 9+ Years - Hyderabad

We are looking for a seasoned US Healthcare Claims professional to join a Concept Research & Exploratory team within a Data Mining Centre of Excellence. The role focuses on identifying claims patterns, anomalies and potential overpayments across Medicare, Medicaid and Commercial healthcare businesses and translating claims expertise into actionable data-driven solutions.

Location: Hyderabad

Your Future Employer

Our client is a leading organization working in the US Healthcare and Claims domain, with a strong focus on payment integrity, claims analytics and data-driven solutions. This opportunity will allow you to work closely with analytics, product and strategy teams to solve complex claims and payment challenges.

Responsibilities

1. Lead exploratory analysis of claims data to identify utilization patterns, anomalies, overpayments and inappropriate payments.
2. Apply strong knowledge of US healthcare claims, CMS rules, reimbursement, contracts and claims workflows to guide investigations.
3. Perform 360-degree claims reviews and reverse engineer claims outcomes to identify the root cause of payment issues.
4. Translate claims and operational insights into data-mining use cases and solution concepts for analytics and product teams.
5. Partner with cross-functional teams and validate data-driven findings against real-world claims and payment processes.

Requirements

1. 7+ years of experience in US Healthcare Claims, with strong exposure to claims adjudication.
2. Extensive experience in Medicare, Medicaid and/or Commercial healthcare claims.
3. Strong hands-on experience in Payment Integrity, Claims Auditing, Overpayment Identification or Recovery.
4. Experience identifying claims patterns, anomalies and inappropriate payments within large claims datasets.
5. Exposure to claims analytics, data mining or payment integrity data-mining initiatives.
6. Strong understanding of CMS rules, reimbursement, contract interpretation and claims workflows.
7. Ability to bridge claims operations with analytics and data-driven solutions.
8. Excellent communication skills with the ability to explain complex claims concepts to technical and non-technical stakeholders.

What is in it for you

1. Opportunity to work on complex US Healthcare Claims and Payment Integrity initiatives.
2. Exposure to exploratory data mining and advanced claims analytics.
3. Opportunity to collaborate with Analytics, Product, Strategy and other cross-functional teams.
4. Work on identifying and solving real-world claims payment and overpayment challenges.
5. Opportunity to contribute as a Claims Domain SME to the development of data-driven solutions.

Disclaimer

Crescendo Global specializes in Senior to C-level niche recruitment. We are passionate about empowering job seekers and employers with an engaging, memorable job search and leadership hiring experience. Crescendo Global does not discriminate on the basis of race, religion, color, origin, gender, sexual orientation, age, marital status, veteran status or disability status

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