JOB DESCRIPTION Job Summary

Leads and supervises team responsible for claims activities including administering claims payments, maintaining claim records, and providing counsel to Providers regarding coverage amount and benefit interpretation. Also monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with cost-control standards.

**Essential Job Duties**

• Coordinates workflow and staffing of day-to-day claims activities and assigns and monitors work of staff in order to adhere to productivity and quality standards.
• Hires, onboards, trains, supervises, and develops claims team, and demonstrates accountability for team performance.
• Proactively plans for daily claims priorities, and responds to new priorities and process improvement opportunities assigned by leadership.
• Ensures execution of claim handling strategies including appropriate determination of coverage, processi...