Manager – Data Mining, Exploratory Intelligence

Jobtailor; Hyderabad; Hybrid; INR 1,800,000 - 3,000,000; Full time

Job summary

Jobtailor in Hyderabad, India seeks a senior claims analytics expert to lead data-driven reviews of paid claims, identify anomalies, and guide remediation with cross-functional teams. You will apply CMS rules and adjudication knowledge to drive investigations and system improvements.

The role emphasizes translating insights into actionable analytics use cases for product and strategy teams, with strong communication to stakeholders and a focus on preventing overpayments.

Qualifications

• 7+ years of experience in US healthcare claims with a strong focus on claims adjudication and data mining payment integrity.
• 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, including analytics, product, strategy, and 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
• Bachelor's degree

Responsibilities

• Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
• Apply knowledge of CMS rules, contract interpretation, reimbursement, and workflows to guide data mining and investigative efforts
• Reverse engineer claims outcomes to understand root causes of payment issues and system behaviors
• Translate operational and claims insights into use cases, concepts, and solution ideas for analytics and product teams
• Partner with analytics, product, and strategy teams to align solutions with real-world claims operations
• Validate data-driven findings against practical claims and payment realities
• Communicate insights, risks, and opportunities to technical and non-technical stakeholders
• Support refinement and scaling of claims monitoring and overpayment detection capabilities

Skills

Analytical mindset

Communication skills

Cross-functional collaboration

Data mining

Claims adjudication

Payment integrity

Root cause analysis

Education

Bachelor's degree

Job description

• Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims


• Apply knowledge of CMS rules, contract interpretation, reimbursement, and workflows to guide data mining and investigative efforts


• Reverse engineer claims outcomes to understand root causes of payment issues and system behaviors


• Translate operational and claims insights into use cases, concepts, and solution ideas for analytics and product teams


• Partner with analytics, product, and strategy teams to align solutions with real-world claims operations


• Validate data-driven findings against practical claims and payment realities


• Communicate insights, risks, and opportunities to technical and non-technical stakeholders


• Support refinement and scaling of claims monitoring and overpayment detection capabilities

Requirements

• 7+ years of experience in US healthcare claims with a strong focus on claims adjudication and data mining payment integrity


• 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, including analytics, product, strategy, and 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


• Bachelor's degree

Core Competencies

Demonstrates expertise in US healthcare claims, focusing on claims adjudication, data mining, and payment integrity. Capable of translating complex claims insights into actionable solutions while collaborating effectively with cross-functional teams.

Highest-signal resume keywords

• Claims Adjudication


• Data Mining


• Payment Integrity


• Claims Analytics


• Cross-Functional Collaboration

Hard Skills

• Claims Review


• Auditing


• Pattern Identification


• Anomaly Detection


• Root Cause Analysis


• Data Validation


• Operational Insights


• Solution Development


• Claims Monitoring


• Overpayment Detection

Soft Skills

• Analytical Mindset


• Excellent Communication

Industry Keywords

• Medicare


• Medicaid


• Commercial Business


• CMS Rules


• Reimbursement


• Claims Operations


• Data-Driven Findings


• Non-Clinical Programs