Senior Manager/ Manager/ Assistant Manager

We are seeking a Claims Domain subject matter Expert in our CRE – Concept research & exploratory team within our Datamining COE for exploratory claims analysis and support the development of advanced data mining capabilities.

This role will focus on identifying claims patterns, anomalies, and potential overpayments across Medicare, Medicaid and commercial business, while translating deep operational insight into actionable analytics concepts and solutions. The ideal candidate brings extensive hands-on claims experience and can reverse engineer claims behavior to inform data-driven strategies, tools, and controls.

7+ years of experience in US healthcare claims with a strong focus on claims adjudication and Data Mining payment Integrity

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