Strong understanding of provider reimbursement methodologies, claims adjudication processes, delegated reimbursement models, managed care contracting principles, Medicare Advantage, population health, risk adjustment, STARS, HEDIS, quality improvement programs, and healthcare operations. Provides strategic oversight to ensure contracted providers are reimbursed in accordance with negotiated contract terms and reimbursement methodologies by partnering with Claims Operations, Network Contracting, and Finance to identify trends, resolve systemic issues, and improve provider satisfaction.