JOB DESCRIPTION Job Summary

Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations and contractual compliance.

Essential Job Duties

• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure.
• Performs daily troubleshooting procedures to support enrollment, disenrollment, claims, and claims support functions as needed.
• Coordinates workflow and staffing of day-to-day activities, and assigns and monitors work of staff to adhere to productivity and quality standards.
• Participates in or leads quality improvement efforts to improve claims processes and/or policies.
• Serves as operations subject matter expert, provides training, mentoring and support to team personnel.

Job Requirements

• At least 4 ye...