Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration, edit logic, benefit loading accuracy, provider and contract data integrity, accumulator logic, dispute root cause remediation, operational readiness, provider experience, and downstream member outcomes for new products, regulations, contracts, and enterprise initiatives. Drives affordability through payment integrity, configuration discipline, and disciplined claims controls, including pre-payment and post-payment review, clinical and non-clinical editing, duplicate detection, unbundling, upcoding, billing anomaly detection, provider audits, coordination of benefits, and high-dollar claims review.