EXL · 3 hours ago
Manager - Data Mining & Exploratory Intelligence (Behavioral Health)
United States
Full-time
Remote
Senior Level, Lead/Staff
9+ years expEXL is seeking a Behavioral Health Claims Domain subject matter expert to join their Concept Research & Exploratory team within the Data Mining Center of Excellence. This role focuses on analyzing behavioral health claims data to identify patterns, anomalies, and potential overpayments, translating operational insights into actionable analytics.
AnalyticsBankingOutsourcing
Responsibilities
Lead exploratory analysis of behavioral health claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
Apply deep knowledge of BH billing rules, coding, 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
Qualification
Required
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
Company
EXL
EXL is a provider of Transformation and Outsourcing services to Global 1000 companies in multiple industries
10001+ employees
H1B Sponsorship
EXL has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2020 (1)
Funding
Current Stage
Public CompanyTotal Funding
$150MKey Investors
The Orogen GroupFTV Capital
2018-10-02Post Ipo Debt· $150M
2006-10-20IPO
2004-12-01Series Unknown
Leadership Team
Rohit Kapoor
Chairman & Chief Executive Officer
Brad Burdick
SVP, Insurance Domain Platforms
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