Manager / Senior Manager - Claims Domain SME - Claims Adjudication & Payment Integrity - Data Mining - US Healthcare - 9+ Years - Hyderabad

We are looking for a Claims Domain SME with strong expertise in US Healthcare Claims, Claims Adjudication, Payment Integrity and Data Mining. The role will focus on identifying claims patterns, anomalies and potential overpayments, while partnering with analytics and product teams to build data-driven solutions.

Location: Hyderabad

Your Future Employer: A leading global analytics and operations management company with deep expertise in the US Healthcare domain.

Responsibilities:

1. Analyze claims data to identify utilization patterns, anomalies and potential overpayments.
2. Leverage knowledge of CMS rules, reimbursement and claims workflows to support investigations.
3. Perform root-cause analysis of claims outcomes and payment issues.
4. Translate claims insights into analytics, data-mining use cases and solution concepts.
5. Collaborate with analytics, product and strategy teams to validate and scale payment integrity solutions.

Requirements:

1. 7+ years of experience in US Healthcare Claims with strong claims adjudication expertise.
2.



Strong experience in Claims Review, Claims Audit and Payment Integrity.
3. Expertise in Overpayment Identification, Payment Accuracy or Recovery.
4. Exposure to Claims Data Mining / Claims Analytics and identification of anomalies and patterns.
5. Experience across Medicare, Medicaid or Commercial Healthcare, with knowledge of CMS rules and reimbursement.

Whats in it for you? Lead innovative initiatives in US Healthcare Payment Integrity

Work closely with Analytics, Product and Strategy teams

Leverage claims expertise to shape data-driven solutions

Chance to drive large-scale claims monitoring and overpayment detection

Reach Us: If you feel this opportunity is well aligned with your career progression plans, please feel free to reach me with your updated profile at [email protected] for a confidential discussion on role.

Keywords: US Healthcare Claims, Claims Adjudication, Payment Integrity, Claims Audit, Claims Review, Claims Analytics, Data Mining, Overpayment, Payment Accuracy, Medicare, Medicaid, Commercial Claims, CMS, Claims Operations, Healthcare Analytics

📌 Manager - Claims & Payment Integrity- US Healthcare- 9+ Yrs- Hyderabad
🏢 Crescendo Global Leadership Hiring India
📍 Hyderabad