JOB DESCRIPTION Job Summary

Leads and supervises team responsible for configuration oversight activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and system requirements as it pertains to auditing of contracting, benefits, prior authorizations, fee schedules and other business requirements.

**Essential Job Duties**

• Supervises configuration oversight (Claim Audit) team, and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements.
• Oversees end-to-end audits, internal operating controls and processes/practices for operational areas including claims, configuration, provider operations, etc.
• Ensures completion of timely audits and compliance with audit standard...