Senior Manager/ Manager/ Assistant Manager

EXL; Hyderabad; On-site; INR 1,800,000 - 3,000,000; Full time

Job summary

EXL in Hyderabad seeks a Claims Domain expert to join the CRE - Concept research & exploratory team within our Datamining COE for exploratory claims analysis and to support the development of advanced data mining capabilities.

This role focuses on identifying patterns, anomalies, and potential overpayments across Medicare, Medicaid, and commercial business, translating insights into actionable analytics concepts and solutions for data-driven decision making.

Qualifications

• 7+ years of experience in US healthcare claims.
• Strong focus on claims adjudication and data mining for payment integrity.
• Ability to reverse engineer claims behavior to inform analytics strategies.

Responsibilities

• Analyze claims data to identify patterns, anomalies, and potential overpayments.
• Translate insights into analytics concepts and solutions.
• Develop and support advanced data mining capabilities within the Datamining COE.
• Collaborate with CRE and analytics teams to drive data-driven strategies.

Skills

Claims analysis

Data mining

Healthcare claims

Adjudication

Analytics

Education

Bachelor's degree in Healthcare/Analytics or related field

Tools

SQL

Python

Job description

We are seeking a 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 business, 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.

7+ years of experience in US healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity