Senior Manager

Job Description_Contingency _Data Mining ; ;Job Name:Sr. Manager - Datamining ;Position Title: ;Sr. Manager ;Band:C2 ;ERP Full Position ID: ; ;Reporting to:SAVP ;Location/Site:EXL India ;Overview ;Candidates should have minimum 15+ years of experience and must have in-depth knowledge in claims adjudication process and its processing methods. Data mining experience will be an added advantage. ;Qualifications:Graduation is MandatoryClaims adjudication experience is MandatoryPrefer candidates with experience in Post adjudication/overpayment projects. ;Experience:Claims Adjudication experience: Minimum 15 yearsOverpayment experience. ;Communication: ;Strong written (documentation) and oral communication skills ;Working Hours:40 hours per week as Full-time employeeShift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)Weekends: Off ;Telecommuter/Internet requirements, if applicable:High Speed internet connection at home, must be broadbandMust understand and adhere with telecommuter policy ;KnowledgeExtensive knowledge and thorough understanding of healthcare payer analytics specifically the business model for datamining operations.Expert in US healthcare system and Billing guidelines. ;Experience15+ years of experience in datamining line of business as a Subject Matter Expert with proficiency building new concepts and patterns.Mandatory work experience with Humana system in datamining line of business.Advanced skills in provider contracts review and through knowledge of Humana systems / applications.Well-developed capabilities in identifying 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. ;Roles and Responsibilities ; ;Will be responsible for bringing in new queries/concepts for datamining program.Providing models and patterns for new development for datamining line of business.The position is purely metrics and target driven in the perspective of bringing in new queries/concept into the table to leverage gaps that exist in client system or client contract.The position will be responsible to bring in client savings to the tune through new research queries/concept.The position will be strictly evaluated based on the new queries that has been brought in and the quantum of the savings.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.Provide detailed analysis of research project(s) data in written and graphic report form to be presented to management center if required.Ability to establish priorities, work independently, and proceed with objectives without supervision.Working under general supervision, plan and carry out research project(s) in accordance with general plans. Conduct a series of experiment as part of a larger project.This position provides administrative and secretarial support to the Program Leader. Responsibilities include report preparation and management, coordination of process development.Ability to take ownership of projects from planning through to execution and multitask and prioritize to manage multiple assignments. ;Team Building activityAssisting with the end user Training in the functionality of the new SMEs on board.Ability to interact with colleagues, supervisors and build relationships with people in an open, friendly, and accepting manner.Provide detailed analysis of research project(s) data in written and graphic report form to be presented if required.Developing and maintaining daily, weekly, monthly and quarterly reports and Key Performance reports.Ability drive to innovate and optimize the use of available resources. ; ; ; ; ;