Lead Assistant Manager - Datamining

Working Hours: Full-time role (40 hours/week). Shift: 08:00 AM – 05:00 PM IST (subject to change based on project requirements). Weekends: Off (may vary based on business needs). Telecommuter/Internet requirements, if applicable: High Speed internet connection at home must be broadband. Must understand and adhere with telecommuter policy 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. Experience: Claims Adjudication experience: Minimum 9 years Overpayment experience. Prefer candidates with experience in Post adjudication/overpayment projects. Qualification: Graduation is mandatory.