Manager, Data Mining - Payment Integrity

Role overview Lead a team of data mining auditors focused on post-payment payment integrity for a health insurance organization. The position drives recovery and savings targets by overseeing vendor management, daily operations, and algorithm development in partnership with technology and data science groups. This is a fully remote role reporting to the Associate Director of Payment Integrity.

Responsibilities - Oversee quality control for vendor data mining submissions, ensuring accuracy and alignment with program standards - Manage day-to-day team operations, strategically assigning work between internal auditors and external vendor partners - Design and refine team workflows and guidelines that produce consistent, measurable outcomes - Train, coach, and mentor team members to build proficiency and effectiveness - Collaborate with technology and data science teams to develop algorithms that identify savings and recovery opportunities - Ensure compliance with all applicable laws and regulations and complete other duties as assigned

Requirements - Bachelor's degree, or 4+ years of commensurate experience in lieu of a degree - 4+ years of experience in healthcare operations - 2+ years of experience leading and developing a team - 2+ years of experience designing, implementing, and improving business workflows

Nice to have - 2+ years of payment integrity experience at a health plan or vendor organization - Background in healthcare claims adjudication - Working knowledge of SQL for querying and analysis - Medical coding certification such as AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

Benefits and work setup - Base pay range of $100,602 to $132,040 per year, with eligibility for an annual performance bonus - Full-time benefits including medical, dental, and vision coverage; 11 paid holidays; paid sick time; paid parental leave; 401(k) participation; life and disability insurance; and paid wellness time and reimbursements - Fully remote with eligibility limited to specific metropolitan areas; future models may shift toward hybrid presence at a hub office - Unlimited vacation program