Role Overview
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
Lead 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.
Qualifications
Bachelor'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
