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Develop and maintain reports and database programs to extract, manipulate, and present Medicare claims data. Validate data integrity, perform statistical analyses, create graphics and narratives, support ad hoc requests, and produce documentation and guidelines. Collaborate with cross-functional teams and identify improvement opportunities.

Serve as day-to-day client account lead for assigned accounts: resolve client issues and escalations, coordinate internal teams for implementations, assess and code client benefits, monitor deliverables, train clients on e-billing, and ensure accuracy of member-facing materials.

Lead small-to-medium IT projects from inception through implementation, managing scope, schedule, budget, risks, resources, communications, and documentation. Ensure adherence to project management methodologies, audit standards, and stakeholder expectations while resolving issues and escalating as needed.

Assist in execution of financial, compliance, and operational audits; evaluate internal controls; test procedures and document findings; prepare audit reports with corrective recommendations; perform special studies (including fraud prevention); and support other auditors to improve audit efficiency.

Manage daily service and administrative operations for large group market, lead and develop staff, oversee sales and retention programs, monitor marketplace trends, implement product and marketing plans, train personnel, ensure quality and process improvements, and maintain customer service standards.

The Senior Proposal Specialist develops high-quality proposals for strategic RFPs and RFIs, coordinating with sales and SMEs while managing proposal processes and crafting compelling narratives.

Audit and adjudicate medical stop loss claims, authorize reimbursements within limits, and identify cost-mitigation and subrogation opportunities. Initiate investigations and vendor referrals, interpret plan language, communicate with carriers and vendors, generate claims reports, adjust reserves, and assist with form development, internal auditing, and training of claims auditors.

Acts as primary day-to-day contact for assigned clients, resolves service issues, supports client implementations and training, ensures accuracy of client/member materials, and coordinates with internal teams to meet client needs.

Support the sales team by managing RFPs, client references, and partner relationships; improve sales processes; develop presentations and materials; gather market and competitive intelligence; and coordinate cross-functional execution to ensure timely, high-quality sales outcomes.

Coordinate and perform testing for system enhancements: create/review test matrices, execute test cases, document and research system issues, liaise between production operations and IT, and prepare reports with recommendations.