Vālenz® Health

• Serve as the primary compliance liaison for Care Management and Utilization Management operations, providing strategic guidance and oversight to ensure adherence to applicable regulatory and accreditation requirements • Interpret, assess, and operationalize regulatory standards, including CMS Medicare Advantage and Managed Care requirements, NCQA and URAC accreditation standards, Utilization Review and Utilization Management regulations, and 42 CFR Part 2 requirements, as applicable • Oversee and support the organization’s multi-state Utilization Management licensing program by tracking licensing requirements across applicable jurisdictions, coordinating license applications and renewals, maintaining supporting documentation, and partnering with operational leaders to ensure ongoing compliance with licensing conditions and regulatory obligations • Provide compliance guidance and subject matter expertise related to clinical workflows, operational processes, policy development, and system implementations impacting Care operations • Support the full lifecycle management of Care-related policies, standard operating procedures, and associated documentation • Monitor regulatory developments and emerging compliance requirements, evaluate operational impact, and communicate relevant updates and recommendations to key stakeholders • Participate in high-risk initiatives, operational enhancements, and product or process changes to ensure compliance considerations are appropriately addressed • Support organizational readiness for audits, regulatory reviews, and accreditation activities, including NCQA and URAC surveys • Assist with incident response activities involving Care operations, including privacy-related inquiries, compliance investigations, and regulatory escalations • Collaborate with Corporate Compliance and cross-functional teams on issue intake, triage, tracking, remediation, and resolution efforts • Provide education, training, and ongoing guidance to internal stakeholders regarding applicable regulatory and compliance requirements • Maintain accurate and organized documentation to support compliance activities, regulatory inquiries, audits, and accreditation requirements

• Serve as the primary compliance liaison for Payment Integrity and Payment Operations, providing strategic guidance on regulatory and operational compliance matters. • Interpret, analyze, and operationalize applicable regulatory requirements, including the No Surprises Act (NSA), Fraud, Waste & Abuse (FWA) laws, CMS requirements, and state Department of Insurance (DOI) regulations impacting payment and billing practices. • Provide compliance oversight and guidance related to payment workflows, reimbursement methodologies, claims administration processes, and product development initiatives. • Partner cross-functionally with operational leaders to identify, assess, and mitigate financial and regulatory compliance risks associated with payment and claims functions. • Monitor and evaluate emerging regulatory developments, enforcement trends, and industry guidance to determine operational impact and support implementation of required changes. • Support the development, review, implementation, and maintenance of financial and payment-related policies, procedures, and standard operating procedures (SOPs). • Participate in high-risk initiatives, system implementations, process enhancements, and product changes to ensure compliance considerations are appropriately addressed. • Assist with incident response activities involving payment disputes, FWA-related escalations, regulatory inquiries, and other compliance-related matters. • Support internal audits, external audits, client audits, and regulatory examinations by coordinating documentation, responding to inquiries, and ensuring audit readiness. • Collaborate with Corporate Compliance and cross-functional stakeholders on issue intake, triage, investigation support, tracking, corrective action planning, and resolution activities. • Develop and deliver training, education, and compliance guidance to internal stakeholders regarding applicable regulatory requirements, policies, and operational expectations. • Maintain accurate and organized documentation supporting compliance oversight activities, monitoring efforts, investigations, and audit preparedness.

• Oversee and execute all aspects of the new client implementation process, ensuring a seamless onboarding experience and setting clients up for long-term success • Manage the rollout of new products and innovations for existing clients, coordinating with internal teams to ensure smooth integration and adoption • Handle client configuration requests in partnership with the Client Success team to support ongoing client needs and optimize platform usage • Lead and drive process improvement initiatives aimed at enhancing implementation strategies, client operations, and project management practices • Develop and present recommendations to increase efficiency, streamline workflows, and enhance the overall client implementation experience • Maintain accurate and timely task management, documentation, and status updates within SalesForce, Wrike, Trello, and other internal Valenz tools

• Receive inbound calls, faxes, and web requests from providers and/or clients • Initiate and facilitate the authorization process in accordance with established health plan policies and procedures • Document demographic information obtained from telephonic, fax, or emailed requests within the care management system • Make outbound calls to follow up on discharge information or request updated clinical information as necessary for concurrent review • Screen inquiries to determine the services that require certification at the time of the inquiry • Obtain clinical information and forward the caller to the clinical staff for completion of the review • Provide certification based upon scripted clinical algorithms or benchmark Length of Stay • Collaborate and effectively communicate with internal and external partners • Stay up to date on Summary Plan Documents and other related resources related to service requests • Ensure applicable URAC standards, Confidentiality/HIPAA standards, and internal policies, practices, and productivity metrics are met • Performs other related duties as assigned by supervisor.

• Review medical bills to identify appropriate billing, coding, and savings opportunities. • Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review. • Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings. • Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries. • Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis. • Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies. • Provide guidance and mentor junior analysts in claim review best practices. • Assist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development. • Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures. • Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction. • Ensure compliance with HIPAA and other regulatory standards. • Perform other duties as assigned.

• Drive Enterprise Growth • Develop and execute a strategic territory plan focused on acquiring large national and regional health plans and TPAs, with an emphasis on net-new logo growth and enterprise expansion. • Identify, qualify, and close complex enterprise opportunities for Valenz Payment Integrity solutions, including claims review, bill review, and cost containment services. • Own the full enterprise sales cycle from prospecting and discovery through proposal development, contract negotiation, and implementation handoff. • Maintain disciplined pipeline management, accurate forecasting, and detailed CRM documentation to ensure revenue visibility and predictability. • Lead Consultative Sales Engagements • Lead consultative sales engagements aligned to enterprise priorities such as medical cost reduction, claims accuracy, regulatory compliance, and operational efficiency. • Drive value-based sales discussions supported by analytics, ROI modeling, and competitive differentiation within the payment integrity landscape. • Navigate multi-stakeholder buying environments across Claims, Finance, Actuarial, Network Management, Operations, Procurement, and Executive leadership. • Develop and deliver executive-level presentations, RFP responses, and finalist pitches that clearly articulate measurable financial impact. • Build Strategic Relationships • Build and cultivate executive-level relationships (CFO, COO, CIO, SVP of Claims, VP of Network, and other senior leaders) to position Valenz as a strategic partner. • Partner with clinical, analytics, legal, finance, product, and operations teams to design customized solutions that meet complex client requirements. • Identify cross-sell and upsell opportunities within enterprise clients in partnership with internal stakeholders. • Represent the Market and the Brand • Monitor industry trends, regulatory changes, and competitive activity within the health plan and TPA markets to inform sales strategy. • Represent Valenz at national conferences, industry forums, and executive networking events to enhance brand presence and generate strategic opportunities.

• Collaborate with business partners to gather, interpret, and document business requirements, including data discovery, policies, procedures and analysis. • Collaborate with cross-functional teams, including Product, Client Delivery, Data Integration, Engineering and Analytics, to enhance existing data workflows and processes. • Assist in supporting technical teams and business stakeholders, translating complex data concepts into clear, actionable insights. • Utilize SQL and related tools to support data-driven decision-making through reports, dashboards, and data extracts. • Ensure data accuracy, integrity, and consistency across systems through data validation, reconciliation, and quality checks. • Conduct file testing during implementations to validate data accuracy, completeness, and compliance with specifications. • Conduct root cause analysis on complex data issues and ensure findings are documented and incorporated into process improvements. • Troubleshoot application or process issues, document findings, and recommend solutions. • Work within Databricks and related data platforms to support, document, and optimize data workflows and pipelines. • Work within Azure DevOps to identify, track and maintain individual and team initiatives. • Support automation and optimization of data-related tasks and reporting processes to improve efficiency. • Investigate and troubleshoot data issues, performing root cause analysis with guidance as needed.

• Collaborate with business partners to gather, interpret, and document business requirements, including data discovery, policies, procedures and analysis. • Collaborate with cross-functional teams, including Product, Client Delivery, Data Integration, Engineering and Analytics, to enhance existing data workflows and processes. • Assist in supporting technical teams and business stakeholders, translating complex data concepts into clear, actionable insights. • Utilize SQL and related tools to support data-driven decision-making through reports, dashboards, and data extracts. • Ensure data accuracy, integrity, and consistency across systems through data validation, reconciliation, and quality checks. • Conduct file testing during implementations to validate data accuracy, completeness, and compliance with specifications. • Conduct root cause analysis on complex data issues and ensure findings are documented and incorporated into process improvements. • Troubleshoot application or process issues, document findings, and recommend solutions. • Work within Databricks and related data platforms to support, document, and optimize data workflows and pipelines. • Work within Azure DevOps to identify, track and maintain individual and team initiatives. • Support automation and optimization of data-related tasks and reporting processes to improve efficiency. • Investigate and troubleshoot data issues, performing root cause analysis with guidance as needed.

• Own and lead the clinical bill review function, setting strategic direction aligned with organizational objectives, client expectations, and growth priorities. • Oversee and optimize the contract lifecycle management (CLM) system, ensuring data integrity, governance, and scalability to support operational and financial outcomes. • Establish and evolve performance management frameworks, including KPIs, productivity standards, and quality benchmarks that drive accountability and continuous improvement. • Drive program effectiveness and scalability, evaluating operational performance and implementing initiatives that enhance consistency, efficiency, and financial impact. • Lead workforce strategy, including capacity planning, organizational design, and resource allocation to meet current and future business demands. • Own end-to-end operational performance, including quality, turnaround times, savings outcomes, and overall service delivery excellence. • Leverage data and analytics to identify trends, systemic gaps, and optimization opportunities, translating insights into actionable strategies. • Champion operational excellence initiatives that reduce rework, increase throughput, and improve overall efficiency across the clinical review lifecycle. • Provide direct leadership and accountability for team performance, fostering a high-performance culture and ensuring alignment to defined standards and goals. • Design and govern quality assurance frameworks, including audit methodologies, review standards, and continuous feedback loops. • Ensure compliance with client plan documents, regulatory requirements, and internal policies, proactively identifying and addressing risk. • Identify and mitigate enterprise-level risks, implementing controls and escalation pathways to protect organizational and client interests. • Provide executive-level oversight on complex, high-risk, or escalated determinations, ensuring consistency and defensibility of decisions. • Drive financial performance of the clinical bill review program, including savings optimization and value delivery to clients. • Develop and deliver executive reporting and insights, communicating performance, risks, and opportunities to senior leadership and key stakeholders. • Identify and lead opportunities for revenue growth, cost containment, and program expansion, contributing to broader business strategy. • Serve as a subject matter expert and strategic partner, supporting pricing, client engagements, and growth initiatives across the organization. • Partner cross-functionally with Product, Technology, Compliance, and Client teams to shape tools, workflows, and solutions that improve outcomes and client value. • Influence system strategy and process design, driving enhancements that enable scalability, standardization, and automation across the function. • Act as a senior escalation point for complex client and provider issues, ensuring timely resolution while preserving relationships and organizational integrity. • Represent the clinical bill review function in enterprise initiatives and strategic planning efforts, ensuring alignment with broader organizational priorities. • Lead and contribute to special projects and evolving business needs, demonstrating adaptability and ownership beyond core responsibilities.

• Lead pre- and post-sale presentations and coordinate regular client meetings to maintain strong relationships and ensure alignment on goals and services. • Drive revenue growth through upselling, cross-selling, and strategic account planning across assigned clients. • Manage and track sales opportunities using the CRM system to ensure accurate pipeline visibility and follow-up. • Oversee client proposals, renewals, and implementations, ensuring timely and effective execution in collaboration with internal teams. • Develop and maintain Strategic Account Plans that outline client goals, key initiatives, and growth opportunities. • Serve as the primary client contact, ensuring timely communication, issue resolution, and overall satisfaction. • Demonstrate strong knowledge of Vālenz products and services, effectively aligning solutions with client needs. • Collaborate with internal teams to resolve client issues, improve service delivery, and streamline processes. • Ensure compliance with company policies, procedures, and HIPAA standards in all client interactions. • Partner with Operations, SMEs, and other departments to meet client requirements and strengthen relationships.