{"id":3462104,"url":"https://alion.io/job/exl-data-mining-specialist-payment-integrity","title":"Data Mining Specialist (Payment Integrity)","company":{"id":38016,"name":"EXL","domain":"exlservice.com","url":"https://alion.io/company/exl","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Oracle","truth_index":{"grade":"B","score":75,"open_postings":236,"ghost_share":0,"stale_share":0.987,"repost_share":0,"time_to_fill_p50_days":27,"computed_at":"2026-11-03T05:54:40Z"}},"role":"Data Science","role_family":"Data Science","seniority":"senior","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":93900,"max":134100,"currency":"USD","period":"year","gross":null,"usd_annual":134100},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Excel","optional":false},{"name":"Outlook","optional":false}],"status":"live","first_seen_at":"2026-10-29T11:58:08Z","employer_posted_date":"2026-10-29","last_verified_at":"2026-11-03T04:24:21Z","board_verified":true,"closed_at":null,"days_open":5,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":5},"description":"The Data Mining Specialist role will require a high level of expertise in identifying, developing, and implementing effective data mining queries. This individual must have extensive knowledge across multiple lines of business, including Medicare, Medicaid, and Commercial claims, as well as experience navigating multiple claims payment systems. The role also requires the ability to analyze complex claims, identify payment anomalies and new recovery opportunities, and translate findings into accurate, actionable data mining concepts. These capabilities are critical to maintaining a strong pipeline of opportunities and adapting concepts and query logic across different client environments.\n*Base Pay Range: $93,900 - $134,100/yr\nFor more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits\nAccess client claim systems to validate claim reimbursement terms as needed \nRoutinely review client contract systems or files for contractual reimbursement terms \nCreate overpayment rules for data mining\nAnalyze payer data and identify anomalies or aberrant billing practices\nPerform an extensive review of client accounts to determine if correct payments were made to providers\nAccurately reprice complex claims utilizing multiple client claims systems to perform the tasks\nIdentify work files to be audited through a query process\nDocumentation of audit findings to be shared with client\nServe as a resource for junior auditors and new employees\nIdentify and develop/validate new overpayment opportunities and recovery concepts\nServe as a client and program specific SME when called upon in both internal and external settings\nEvaluate current procedures for efficiency and accuracy as well as recommend solutions for process improvements\nConduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures, and programs.\n Required:\nMinimum of 5 years employment within Payment Integrity Services\n\nMinimum 5-8 years or equivalent work experience in healthcare/payment integrity/managed care contracts \nExperience with Medicare, Medicaid, and Commercial claims data\nExperience with industry systems (FACETS, NASCO, Encoder Pro, TrueCode,3M, Webstrat, Pricers)\nSound knowledge of ICD-10, CPT, and HCPC coding guidelines\nExperience with processing complex medical health claims\nKnowledge of CMS Pricing Guidelines and Coding Methodologies\nAttention to detail and ability to problem solve \nExcellent computer skills, proficient in excel, word, and outlook \nExcellent interpersonal skills, and communication skills \nAble to train and delegate \nDemonstrate ability to prioritize tasks \nExcellent organizational skills \nEducation:\nBachelor’s degree or equivalent work experience in Payment Integrity services \nWhat We Offer:\nEXL Health offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class analytics consultants.\nYou can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth\nWe provide guidance / coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.\nThe sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.\n*The posted base salary range is the hiring base salary range for this role. 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