Senior Auditor Data Mining

To support the Payment Integrity team, the full-time Senior Auditor Data Mining will identify healthcare cost-saving opportunities through advanced data mining strategies, claims analysis, and audit development while working remotely. Key Responsibilities Develop and implement data mining strategies to identify claims overpayments and cost-saving opportunities Create and deploy payment integrity edits and auditing methodologies to flag suspect claims Produce detailed data mining reports and analyses to support operational decisions Required Qualifications Minimum high school diploma or GED required Seven or more years of healthcare claims investigation or data mining experience Five or more years of leadership experience in healthcare auditing or payment integrity Demonstrated expertise in healthcare claims processing and reimbursement methodologies Advanced proficiency with Microsoft Excel and ability to utilize SQL Server and Power BI