JOB SUMMARY:Accountable for oversight of Claims Department Training and Auditing Programs. Additionally, this position is responsible for pre-litigation and claim appeal file analysis. This position is responsible for monitoring and identifying inappropriate provider billing patterns. his position will be constantly auditing various provider claims to detect opportunities for improvement in claim payment, contracting and utilization management. Identify risks related to claims processing and work with Claims Operations to develop processing and payment workflows specific to Medicare/Medicare Advantage, Marketplace and Medicaid. JOB SPECIFICATIONS AND CORE COMPETENCIES