• Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. • Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details. • Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information. • Lead the process to measure, track, and report all aggregate claims. • Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. • Provide client audit reporting as needed. • Manage inventory of claims while ensuring best practices and claim standards are met. • Identify new opportunities to track and process claims more efficiently. • Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes. • Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.