• Resolve voluntary out-of-network pricing disputes using MRC, Fair Health, and Medicare methodologies • Analyze pricing data to identify trends, variances, and improvement opportunities • Develop tools, reporting, and insights to support manual and external pricing operations • Collaborate with Claims, Call Center, and matrixed teams to improve pricing accuracy and workflows • Present clear, actionable findings to internal stakeholders • Ensure pricing strategies align with fair reimbursement and cost containment goals

• Lead the execution of pricing dispute resolution activities within Voluntary Out-of-Network cost containment programs • Conduct thorough investigations of pricing disputes to determine appropriate next steps, involved vendors, and resolution pathways • Ensure timely follow-up and resolution in alignment with established turnaround time standards • Maintain accurate, detailed documentation and tracking of all dispute cases • Support external claims pricing dispute resolution by working directly with vendors, providers, and internal stakeholders to ensure accurate pricing methodologies are applied and disputes are resolved efficiently • Serve as a knowledgeable point of contact for internal stakeholders, vendors, and providers • Provide guidance and feedback to Claims and Call Center teams related to dispute resolution processes • Demonstrate professionalism and a strong commitment to customer satisfaction in all interactions • Compile and analyze data to identify trends, gaps, and opportunities for improvement • Support the development of reports and tools used to monitor program performance • Contribute to process improvement initiatives and support operational change efforts

• Ensures data integrity is maintained throughout the reporting lifecycle. • Implements reporting and reconciliation workflows and document processes. • Responsible for experience studies and medical trend studies. • Responsible for running queries and providing required analysis to understand related drivers (such as medical cost and utilization), as well as providing insightful commentary and sensitivity modeling analysis. • Actively supports efforts to continually improve data capabilities and quality of department analysis and reporting. • Reports production to support financial reporting and operations activities. • Performs research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department. • May refer to senior level staff for assistance with higher level problems that may arise. • Performs in-depth claims analysis of baseline and ongoing contract monthly data. • Conducts profitability analysis and drill down analysis into actual expected variances. • Pulls ad-hoc reporting as needed.

• Help define and manage one or more ITIL process areas—such as Incident Management, Service Level Management, Change Management, Configuration Management, or other IT enterprise processes • Support for the Epic Data Courier application and become a Data Courier Administrator • Assist caregivers with system changes, troubleshoot issues, and review related processes to ensure efficiency and compliance • Define current state processes in areas where process is vague, weak, or undocumented • Document future state processes or next iterations of current processes • Define and document design requirements to support all process implementations using Agile Scrum SDLC and/or Waterfall methodologies • Champion organizational change and adoption of service management best practices by providing coaching and training until processes become engrained into the culture • Provide guidance and input to stakeholders, leaders, developers and quality assurance testers throughout the ITSM program • Conduct research, develop, and recommend solutions to integrate people, processes, and technology to improve IT process principles