EXL (NASDAQ: EXLS) is a global data and artificial intelligence ("AI") company that offers services and solutions to reinvent client business models, drive better outcomes and unlock growth with speed. EXL harnesses the power of data, AI, and deep industry knowledge to transform businesses, including the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect.

We are headquartered in New York and have more than 60,000 employees spanning six continents. For more information, visit www.exlservice.com.

Role Title: Data Mining, Exploratory Intelligence

BU/Segment: Insurance

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 role is designed for a senior leader with a strong exploratory data mining background and deep claims expertise, particularly in identifying leakages, overpayments, billing behaviors, and systemic adjudication gaps. This leader will shape what should be analyzed and why, enabling downstream analytics and technology teams to build effective, defensible solutions.

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

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.

Data Mining, Exploratory Intelligence

Benefits

Job Description