Data Mining Manager – Payment Integrity

About the role

Codoxo is seeking a Data Mining Manager to lead its Payment Integrity team. The role involves applying advanced data mining techniques to detect and prevent improper payments, fraud, waste, and abuse across healthcare claims.

Key responsibilities

• Act as the subject‑matter expert for data mining and payment integrity.
• Research and evaluate new data mining concepts for client applicability.
• Utilize Codoxo’s tools and external sources (claims policies, CMS/OIG data, Medicaid plans, etc.) to develop concepts.
• Document concepts for developers and partner with SQL and Python developers to produce efficient outputs.
• Train and mentor team members on process improvements.
• Document validation methods for overpayments and assist with client concept approval forms.

Required profile

• CPC or equivalent coding certification.
• Minimum 5 years of data mining experience, preferably in healthcare payment integrity.
• Proven track record in analyzing complex data sets to identify fraud, waste, and abuse.
• Strong analytical and communication skills.

Required skills

• Microsoft SQL
• Python
• R (or SAS) – mentioned as a plus.