Lead Assistant Manager - Data Mining (Claims Adjudication)

EXL; Pune District, Chennai District, Bengaluru; Hybrid; INR 1,800,000 - 3,200,000; Full time

Job summary

EXL in Pune, India is seeking a Lead Assistant Manager with 9+ years in claims adjudication to lead data mining programs for Medicare or Commercial lines.

You will audit claims, identify overpayments, and drive improvements to reduce false positives, while delivering against strict metrics and targets. Collaborate with cross-functional teams and report to the program Manager; independence and data-driven mindset essential.

Qualifications

• Minimum 9 years in claims adjudication.
• Overpayment experience required.
• Post adjudication/overpayment project experience preferred.

Responsibilities

• Audit Medicare and Commercial claims to identify overpayments using data mining concepts.
• Develop and refine concepts to reduce false positives and realize higher revenue.
• Work on metrics and targets related to claim audits and overpayments.
• Collaborate with cross-functional teams and report regularly to the Manager.
• Maintain independence and drive data-driven decisions with minimal guidance.
• Act as a data-centric thinker focused on program performance.

Skills

Claims adjudication

Data mining

Healthcare analytics

Interpersonal skills

Independent work

Job description

EXL Looking for Lead Assistant manager with a minimum of 9+ years of experience and must have in-depth knowledge of claims adjudication process and its processing methods. Data mining experience will be an added advantage.

Skills and abilities:

• Should have a good understanding of the US healthcare system and management.
• Should have thorough understanding of healthcare payer analytics specifically the business model for datamining operations.
• Preferably candidates should have work experience in the data mining Medicare or Commercial line of business.
• Should have thorough understanding of the payer system loopholes in the claims cost management.
• Should be able to think beyond horizon as ways to clog in those gaps for realizing higher revenue for datamining program.
• Will be responsible for auditing claims on Medicare or Commercial business based various data mining concepts to find overpayments.
• Will be responsible for bringing in new idea to refine concept to remove false positive
• The position is purely metrics and target driven in the perspective of claim audits to initiate overpayment that exist in deployed data mining concepts.
• The position will be strictly evaluated based on the accuracy over claim audits and overpayments identification
• Should possess a strong interpersonal skill set to be able to work well with other people/teams, including in teams or groups, formally and informally.
• Should be able to work independently with minimal guidance.
• Should be purely data and metrics driven person and discuss with Manager on a regular basis on the program/individual

Must have :

• Claims Adjudication experience: Minimum 9 years
  Overpayment experience.
• Prefer candidates with experience in Post adjudication/overpayment projects.