Data Mining and Exploratory Intelligence Lead

Role Title: Data Mining, Exploratory Intelligence

Company: EXL (NASDAQ: EXLS)

Location: Dublin, Republic of Ireland (Flexible hybrid working)

Employment Type: Permanent

Summary of the role

The AVP / SAVP – Claims Data Mining & Exploratory Intelligence will lead the Concept Research & Exploratory function within the Data Mining Center of Excellence (COE). This role is not a traditional analytics delivery position; rather, it serves as a critical bridge between Operations and Analytics, translating deep operational knowledge into scalable, analytics-ready concepts. The ideal candidate brings extensive experience in claims operations and payment integrity, paired with the ability to explore data, reverse-engineer outcomes, and convert operational insight into clear, actionable analytics concepts across Medicare, Medicaid, Behavioral Health, and Commercial lines of business.

As part of your duties, you will be responsible for:

Strategic Leadership & Concept Vision

• Build and lead the enterprise exploratory data mining and concept-development strategy within the COE.
• Establish a structured concept discovery and validation framework focused on claims leakage, overpayments, and inappropriate utilization.
• Identify high-value opportunities for payment integrity through exploratory analysis, hypothesis-driven investigations, and operational insight.
• Prioritize concepts based on risk exposure, recovery potential, operational feasibility, and regulatory impact.
• Act as the thought leader on where analytics should be applied, rather than owning model development itself.

Claims Domain & Exploratory Oversight

• Serve as a senior claims-domain authority, bringing deep expertise across Medicare, Medicaid, Behavioral Health, and Commercial claims.
• Lead exploratory investigations to uncover billing behaviors, payment anomalies, utilization patterns, and adjudication inconsistencies.
• Reverse-engineer claims outcomes to identify root causes such as policy gaps, configuration issues, workflow behaviors, or provider practices.
• Ensure all insights are grounded in real-world claims processing, reimbursement logic, and operational constraints.

Bridge Between Operations & Analytics

• Translate exploratory findings into well-defined analytics concepts, use cases, and business requirements.
• Partner closely with Data Science, Analytics, Product, and Technology teams to ensure concepts are understood, feasible, and scalable.
• Act as the interpreter between operations and analytics teams, ensuring neither loses context.
• Ensure analytics efforts remain aligned with operational realities and business intent.

People & Team Leadership

• Lead and develop a team of senior claims and payment integrity subject-matter experts focused on exploration and concept research.
• Establish governance, success metrics, and quality standards for exploratory initiatives.
• Foster a culture of curiosity, critical thinking, and collaboration across operations and analytics.
• Serve as an escalation point for complex claims behavior, payment integrity, and exploratory challenges.

Cross-Functional Partnership & Influence

• Partner with Payment Integrity, Compliance, Audit, Product, and Enterprise Analytics teams.
• Clearly articulate business risk, opportunity sizing, and ROI tied to proposed concepts.
• Ability to influence through storytelling grounded in claims reality and data-driven insight.
• Ensure smooth handoff of validated concepts to implementation and production teams.

Governance, Validation & Scaling

• Define standards for validating exploratory findings against regulatory, contractual, and operational realities.
• Oversee transition of approved concepts from exploration into production analytics pipelines.
• Support refinement of monitoring, audit targeting, and recovery programs.
• Ensure concepts are defensible, compliant, and operationally executable before scaling.

Qualifications and experience we consider to be essential for the role:

• 15+ years of progressive experience in claims operations, payment integrity, or claims-focused data mining.
• Deep hands-on expertise across Medicare, Medicaid, Behavioral or Commercial claims environments.
• Proven experience identifying claims leakages, overpayments, and inappropriate billing behaviors.
• Strong background in exploratory analysis and hypothesis-driven data mining, not just reporting.
• Demonstrated ability to reverse-engineer claims outcomes and operational workflows.
• Experience acting as a bridge between claims operations and analytics/data science teams.
• Executive-level communication skills with strong influence and storytelling ability.
• Track record of leading senior SMEs and building concept-driven teams.
• Experience contributing to or governing Data Mining or Payment Integrity COEs.

Skills and Personal attributes we would like to have:

• Experience supporting enterprise payment integrity or analytics transformation initiatives.
• Working knowledge (not necessarily hands-on) of advanced analytics techniques such as anomaly detection and pattern recognition.
• Familiarity with regulatory and compliance considerations impacting claims and payment integrity.
• Experience working with large, complex healthcare claims datasets and modern analytics ecosystems.

About EXL:

As part of a leading global Data and AI company, you can look forward to:A competitive salary with a generous bonus, private healthcare, life assurance at 4 x your annual salary, income protection insurance, and a rewarding pension.At EXL, we are committed to providing our employees with the tools and resources they need to succeed and excel in their careers. We offer a wide range of professional and personal development opportunities. We also support a range of learning initiatives that allow our employees to build on their existing skills and knowledge. From online courses to seminars and workshops, our employees have the opportunity to enhance their skills and stay up to date with the latest trends and technologies.As an Equal Opportunity Employer, EXL is committed to diversity. Our company does not discriminate based on race, religion, colour, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, age, or disability status.At EXL, we offer a flexible hybrid working model that allows employees to live a balanced, healthy lifestyle while strengthening our culture of collaboration.

To be considered for this role, you must already be eligible to work in the Republic of Ireland.

Key skills/competency

• Data Mining
• Exploratory Data Analysis
• Claims Operations
• Payment Integrity
• Analytics Strategy
• Concept Development
• Healthcare Claims
• Regulatory Compliance
• Cross-functional Collaboration
• Leadership