Knowledge of: managed care contracting methods; health plan core transaction systems; organization and staffing of the medical claims and claims service functions; provider billing and reimbursement methodologies; policies and procedures utilized in medical claims processing; supervisory and staff development techniques; medical economics; fraud, waste and abuse detection and prevention, performance and workflow improvement, NCQA accreditation and HIPAA complaint claim coding guidelines. Demonstrated success leading Medicare claims operations, implementing operational improvements, modernizing workflows, and achieving measurable gains in efficiency, quality, compliance, and service performance.