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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
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 AdjudicationData MiningPayment IntegrityClaims AnalyticsCross-Functional Collaboration
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ReviewAuditingPattern IdentificationAnomaly DetectionRoot Cause AnalysisData ValidationOperational InsightsSolution DevelopmentClaims MonitoringOverpayment Detection
Soft Skills
Analytical MindsetExcellent Communication
Industry Keywords
MedicareMedicaidCommercial BusinessCMS RulesReimbursementClaims OperationsData-Driven FindingsNon-Clinical Programs
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account EXL Website LinkedIn All Job Openings 10,000+ employees 🏥 Healthcare 🛡️ Insurance 📦 Logistics 💰 $2M Venture Round on 2015-01 Healthcare
- Insurance
- Logistics EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data. Manager – Data Mining, Exploratory Intelligence Job not on LinkedIn 🔥 1 hour ago 🏢🏡 Hyderabad – Hybrid ⏰ Full Time 🟠 Senior 🔴 Lead 📊 Data Scientist 👻 Ghost score 11% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 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 Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Senior Data Science Specialist 🕒 August 26 Randstad 10,000+ employees 💼 Consulting 📣 Marketing 📦 Logistics Website LinkedIn All Job Openings Senior Data Science Specialist building GCP data platforms and automated pipelines for Randstad’s workforce solutions. Supporting MLOps, enterprise integrations, cloud reliability, and FinOps. 🏢🏡 Hyderabad – Hybrid ⏰ Full Time 🟠 Senior 📊 Data Scientist Senior Engineer Consultant – Data Science 🕒 August 21 Verizon 10,000+ employees 📡 Telecommunications 👥 B2C 🏢 Enterprise Website LinkedIn All Job Openings Senior data scientist building agentic AI and analytics solutions for Verizon’s supply chain operations. Developing optimized agents, models, and dashboards from complex data to improve business decisions. 🏢🏡 Hyderabad – Hybrid 💰 $2.3G Post IPO debt on 2025-08 ⏰ Full Time 🟠 Senior 📊 Data Scientist Principal Specialist, Data Science 🕒 August 21 Randstad 10,000+ employees 💼 Consulting 📣 Marketing 📦 Logistics Website LinkedIn All Job Openings Principal Data Science Specialist building scalable GCP and AWS data pipelines for Randstad. Enabling production ML systems, data governance, and data engineering standards. 🏢🏡 Hyderabad – Hybrid ⏰ Full Time 🔴 Lead 📊 Data Scientist Staff Data Scientist, Applied AI 🕒 August 12 Warner Bros. Discovery 10,000+ employees 📱 Media 📡 Telecommunications Website LinkedIn All Job Openings Staff data scientist designing production ML and GenAI solutions for Warner Bros. Discovery’s global media, streaming, and entertainment portfolio. Building LLM, RAG, and AI engineering capabilities. 🏢🏡 Hyderabad – Hybrid ⏰ Full Time 🔴 Lead 📊 Data Scientist Lead Data Advisor 🕒 August 11 SimCorp 1001 - 5000 💼 Consulting 🛡️ Insurance 💳 Fintech Website LinkedIn All Job Openings Lead Data Advisor shaping data governance and client onboarding for SimCorp’s investment management solutions. Monitoring vendor changes and coordinating data standards, testing, and change management for financial clients. 🏢🏡 Hyderabad – Hybrid ⏰ Full Time 🟠 Senior 📊 Data Scientist View More Data Science Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Remote jobs Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources About us Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs