Senior Director, Data Mining

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary
We are seeking a strategic and experienced leader for the role of Senior Director, Data Mining, responsible for overseeing ideation and validation of healthcare payment integrity data mining. This leader will manage a high-performing team to identify, test, and validate concepts that detect improper healthcare payments. The ideal candidate brings deep healthcare analytics expertise and a proven ability to lead teams, drive measurable results, and collaborate cross-functionally in a dynamic environment.

Your Role in Our Mission

• Provide strategic direction and day-to-day leadership for the data mining team focused on uncovering and confirming data-driven audit opportunities.
• Oversee the full data mining lifecycle from opportunity identification and concept design through validation, deployment, and post-audit analysis.
• Apply knowledge of provider billing practices, claim adjudication processes, and regulatory requirements to guide development of actionable audit concepts.
• Establish and track performance metrics to ensure teams meet productivity, quality, and financial objectives.
• Collaborate with IT, Product and Client Services teams to refine, test, and operationalize audit concepts.
• Lead documentation, knowledge sharing, and root cause analysis to inform ongoing audit development and provider education.
• Mentor and develop managers and analysts to support succession planning and skill development across the team.
• Represent the function in client meetings and executive-level discussions to articulate value, methodology, and results.

What We’re Looking For

• Bachelor’s degree required (Healthcare Administration, Data Science, Business, or related).
• Minimum of 10 years of experience in healthcare payment integrity data mining with at least 5 years in a leadership role.
• Strong understanding of healthcare claims data, coding systems (ICD, CPT, DRG), and payment methodologies.
• Demonstrated success in managing ideation and validation processes that produce measurable financial returns.
• Skilled in SQL, Excel, and visualization/reporting tools; experience with SAS, Python, or similar tools preferred.
• Excellent communication and presentation skills; ability to influence cross-functional stakeholders and executives.
• Experience working in or with payer or provider organizations, government healthcare programs, or audit vendors.
• Experience integrating AI/ML into data mining operations.

What You Should Expect in This Role

• Home-based position with flexibility to work from anywhere in the continental US.
• Must have a dedicated workspace and high-speed internet connection suitable for remote collaboration.
• Requires availability during standard business hours for meetings and team interaction.
• Occasional travel (up to 10%) for in-person team meetings or client presentations may be required.
• This role may involve extended hours during high-priority initiatives or client deadlines.

The deadline to submit applications for this posting is August 4, 2025.

The pay range for this position is $137,100.00 - $195,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.