Qualifications: Active Registered Nurse (RN) license in the State of North Carolina with a minimum of three years of clinical experience; OR active LPN, Physical Therapist (PT), or Occupational Therapist (OT) license in North Carolina with at least five years of clinical experience. Respond to member and provider inquiries, identify process improvement opportunities, and help develop corrective actions related to benefits interpretation, policy application, or claims processing issues.