- Involved in claims adjudication activities, ensuring adherence to quality standards, productivity targets, and regulatory requirements. Oversee the day-to-day operations of the claims adjudication. Collaborate with cross-functional teams, including IT, compliance, and customer service, to address operational challenges and improve overall performance.- Develop and implement efficient workflows and procedures(SLAs) to optimize claims processing timelines and accuracy.- Stay updated on industry trends, regulatory changes(HIPAA), and best practices related to healthcare claims adjudication, and ensure team compliance.- Act as a point of escalation for complex claims issues, working closely with team members to resolve disputes and ensure timely resolution.- Analyze performance metrics and KPIs to track performance and identify opportunities for process improvements.