Manager – Data Mining, Exploratory Intelligence (Behavioral Health)
EXL
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Lead exploratory analysis of behavioral health claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
- Apply deep knowledge of BH billing rules, coding, reimbursement, and workflows to guide data mining and investigative efforts
- Perform reverse engineering of claims outcomes to understand root causes of payment issues and system behaviors
- Translate operational and claims insights into clear use cases, concepts, and solution ideas for analytics and product teams
- Partner closely with analytics, product, and strategy teams to ensure solutions align with real-world claims operations
- Validate data-driven findings against practical claims and payment realities
- Clearly communicate insights, risks, and opportunities to both technical and non-technical stakeholders
- Support ongoing refinement and scaling of claims monitoring and overpayment detection capabilities
Requirements
- 10+ years of experience in operations with a strong focus on claims adjudication and payment Integrity
- Extensive experience across Medicare, Medicaid or commercial platforms
- 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 (analytics, product, strategy, compliance)
- Excellent communication skills with the ability to explain complex claims concepts clearly
- Prior involvement in payment integrity, SIU, or recovery initiatives
- Experience supporting or designing claims analytics or data mining programs
- Familiarity with common BH coding schemes, authorization models, and provider billing behaviors
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims adjudicationpayment integrityclaims reviewauditingdata miningbehavioral health billingcodingreimbursementclaims analyticspattern recognition
Soft Skills
analytical mindsetcommunication skillscollaborationproblem-solvingstakeholder engagementcross-functional teamworkconcept translationinsight communicationrisk assessmentoperational alignment