About this role
EXL (NASDAQ
EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.
We are seeking a seasoned 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 platforms, 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.
*Base Pay Range: $93,900- $154,200
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
- Lead exploratory analysis of claims data to identify utilization patterns, anomalies, and potential overpaid or inappropriate claims
- Apply deep knowledge of 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
- 10+ years of experience in operations with a strong focus on claims adjudication and payment Integrity
- Extensive experience across Medicare, Medicaid or/ and 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 coding schemes, authorization models, and provider billing behaviors
*The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.