• Design, build, and automate quality analytics reports using business intelligence tools and databases to support performance monitoring. • Gather and monitor production metrics, analyzing data sets to discover trends and develop actionable business insights. • Generate recurring reports regarding team productivity and operational processes, including volume tracking and workload management. • Manage technical workflows and documentation via Jira, including ticket management for analytics and relaying requirements between operations and engineering teams. • Coordinate quality escalations, reviewing trends across issues such as process changes or panel state updates. • Monitor compliance and quality records, including NCRs, CAPAs, amended reports, and HIPAA-related incidents. • Support process mapping initiatives and identify opportunities for continuous quality and process improvement. • Utilize SQL and statistical packages to perform data analysis, write scripts, and conduct hypothesis testing (e.g., AQLs). • Implement and monitor Statistical Process Control (SPC) to maintain high-quality production standards. • Support organizational training initiatives and maintain compliance with HIPAA/PHI privacy and security requirements. • Meet established deadlines accurately and with a sense of urgency in a fast-paced environment.

• Review and organize litigation responses. Work with various Operations teams to ensure bill review accuracy, defend Rising repricing strategies and updating processes as needed. • Appear as an expert witness on an as needed basis for litigated cases, hearings, depositions and fee coder affidavits. • Drive innovation with bill review repricing strategies ensuring workflow creation and proper documentation. • Drive specialty bill review repricing strategies and product development including but not limited to Rising Fair and Reasonable network reductions, Second Look, Rising Guarantee program etc. • Accurately and appropriately analyze specialty bill review bills, large medical bills and make payment recommendations based on claim history, medical notes, usual and customary rates (UCR), state laws and fee schedules, available PPO contracts, coding guidelines, client instructions, and company policies and procedures. • Maximize productivity through proficient use of various software programs and reference tools, including Vision, Smart Advisor, Excel, Internet, and company-developed applications. • Communicate with medical providers to obtain needed information and resolve bill-specific issues. • Communicate directly with clients, offering them world-class customer service by responding to and answering their questions quickly and professionally. • Participate in ongoing training to enhance job skills and knowledge. • Mentor and train less-experienced Auditors. • Special projects as assigned by management.

• Performing AML alert/case reviews, seeking to mitigate risks associated to financial crimes and suspicious activity. • Applying research and analytic techniques to digest complex information sets in order to make logical and adequately supported determinations in regard to unusual and potentially suspicious activity. • Applying consistent and well-documented analysis consistent with industry standards to ensure success in the following daily efforts of Transaction Monitoring. • Conducting an end-to-end and meticulous review of potential illegal or suspicious activity. • Completing a time-sensitive and meticulous analysis of each instance of potential Anti-Money Laundering activity and/or suspicious financial activity across multiple jurisdictions and countries. • Assessment of customer profiles and client data to identify whether activity is consistent with typical purchasing/payment activity, including Acceptable Use Policy adherence and Know Your Customer efforts. • Documenting findings in narrative style format, in the manual and automated process case management system and prepare updates to Project Managers / Team Leads as appropriate. • Make determinations for potential Suspicious Activity Report (SAR) filings.

• Investigate and respond to consumer complaints • Support internal and external fraud referrals and investigations • Perform agent monitoring and manage regulatory inquiries • Assist in reporting and contribute to policy development • Make recommendations for process improvements