POSITION SUMMARY/RESPONSIBILITIES Governs and assumes accountability for the execution and monitoring of medical and long-term services and supports (LTSS) claims processing, inventory, and adjustments. Directs all claims activities and ensures claims department efficiency and claims payment accuracy. Demonstrates performance and process improvement by monitoring key metrics for the department, proactively identifies issues and improvement opportunities, and conducts frequent updates to health plan leadership. Complies with and enforces organizational and departmental policies and procedures. Actively uses and understands Community First’s claims adjudication system and all systems that interface with the core operating system. EDUCATION/EXPERIENCE A Bachelor’s degree in Business, Health Care or Hospital Management or equivalent experience is required. Minimum of five years’ experience in an insurance, medical or managed care environment, including two years of claim processing experience required. Requires prior leadership experience managing claims departments in the health insurance industry for commercial, Medicaid, and Medicare programs. Experience with QNXT claims adjudication systems is strongly preferred.