As a Data Mining Manager, you will lead the development and execution of data mining strategies across multiple projects. You will be responsible for ensuring that all data mining activities are aligned with the organization�s strategic goals. This role involves managing a larger team, including data analysts, senior associates, and assistant managers, and ensuring that they have the resources and support they need to succeed. You will also be responsible for representing the data mining team in executive meetings, providing insights into how data can drive business decisions.
Key Responsibilities
• Lead exploratory analysis of claims paid data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
• Apply deep knowledge of CMS rules, contract interpretation, 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
ResponsibilitiesLead development and execution of data mining strategies. Ensure alignment with organizational goals. Manage a larger team of data professionals. Represent data mining team in executive meetings. Provide insights to drive business decisions. Develop long-term plans for data mining initiatives. QualificationsBachelor�s degree in Data Science, Computer Science, Statistics, or a related field. 4-6 years of experience in data mining or data analysis.
Required 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 (analytics, product, strategy, 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
Skills Required
- Bachelor’s degree in Data Science, Computer Science, Statistics, or a related field
- 4–6 years of experience in data mining or data analysis
- 7+ years of experience in US healthcare claims, focused on claims adjudication and payment integrity data mining
- Extensive experience with Medicare, Medicaid, or commercial healthcare business
- Expertise in 360-degree claims review, auditing, and payment integrity
- Ability to identify patterns, anomalies, and inappropriate payments within large claims datasets
- Strong analytical mindset and ability to bridge operations and data science
- Experience collaborating with analytics, product, strategy, and compliance teams
- Excellent communication skills for explaining complex claims concepts
- Prior involvement in payment integrity data mining or recovery initiatives
- Experience supporting or designing claims analytics or data mining non-clinical programs
EXL Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about EXL and has not been reviewed or approved by EXL.
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Healthcare Strength — Medical plan options include HSA, HRA, and PPO choices, with additional health-related programs such as disability coverage and an employee assistance program. Feedback suggests these options provide meaningful flexibility and coverage breadth for many roles.
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Leave & Time Off Breadth — Up to 20 days of paid time off, plus federal holidays and paid sick and safe time, are highlighted. Feedback suggests this leave structure is a notable benefit alongside core compensation.
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Retirement Support — A traditional and Roth 401(k) with up to a 3% company match and full vesting after one year is described. Feedback suggests this match and vesting timeline help bolster long-term savings.
EXL Insights
What We Do
Choosing a digital partner is about more than capabilities — it’s about collaboration and character. Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments. At EXL, our collaboration is built on ongoing listening and learning to adapt our methodologies. We’re your business evolution partner—tailoring solutions that make the most of data to make better business decisions and drive more intelligence into your increasingly digital operations. Whether your goals are scaling the use of AI and digital, redesign operating models, or driving better and faster decisions, we’re here to partner with you to help you gain—and maintain—competitive advantage with efficient, sustainable models at scale. Our expertise in transformation, data science, and change management helps make your business more efficient and effective, improve customer relationships and enhance revenue growth. Instead of focusing on multi-year, resource- and time-intensive platform designs or migrations, we look deeper at your entire value chain to integrate strategies with impact. We use our specialization in analytics, digital interventions, and operations management—alongside deep industry expertise — to deliver solutions that help you outperform the competition. At EXL, it’s all about outcomes—your outcomes—and delivering success on your terms. Share your goals with us and together, we’ll optimize how you leverage data to drive your business forward. For more information, visit www.exlservice.com.
