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Manager – Data Mining, Exploratory Intelligence (Behavioral Health)
Location
United States
Posted
39 days ago
Salary
Not specified
Job Description
Job 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
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