Lead Assistant Manager - Data Mining (Claims Adjudication)

EXL Looking for Lead Assistant manager with a minimum of 9+ years of experience and must have in-depth knowledge of claims adjudication process and its processing methods. Data mining experience will be an added advantage.

Skills and abilities:

• Should have a good understanding of the US healthcare system and management.
• Should have thorough understanding of healthcare payer analytics specifically the business model for datamining operations.
• Preferably candidates should have work experience in the data mining Medicare or Commercial line of business.
• Should have thorough understanding of the payer system loopholes in the claims cost management.
• Should be able to think beyond horizon as ways to clog in those gaps for realizing higher revenue for datamining program.
• Will be responsible for auditing claims on Medicare or Commercial business based various data mining concepts to find overpayments.
• Will be responsible for bringing in new idea to refine concept to remove false positive
• The position is purely metrics and target driven in the perspective of claim audits to initiate overpayment that exist in deployed data mining concepts.
• The position will be strictly evaluated based on the accuracy over claim audits and overpayments identification
• Should possess a strong interpersonal skill set to be able to work well with other people/teams, including in teams or groups, formally and informally.
• Should be able to work independently with minimal guidance.
• Should be purely data and metrics driven person and discuss with Manager on a regular basis on the program/individual

Must have :

• Claims Adjudication experience: Minimum 9 years
  Overpayment experience.
• Prefer candidates with experience in Post adjudication/overpayment projects.