**Duties and Responsibilities:** + Manages a team of specialists, with responsibility for goal and productivity management, coaching and counseling, performance management and other leadership responsibilities as assigned. + Delivers training to employees as needed and ensures new hires are on-boarded and trained accordingly. + Ensures Non-Clinical Staff expedite timely requests for information or case acknowledgement letters to meet compliance and productivity goals. + Understands HFs internal health plans policies and procedures to frame decisions. + Interpret regulations and policies as needed. + Makes critical decisions in support of the business as needed. + Manage all duties within regulatory timeframes. + Communicate effectively to hand-off and pick-up work from colleagues. + Additional duties as assigned. **Minimum Qualifications:** + High School Diploma or GED + Excellent oral and written communication abilities. + Proficiency in drafting clear and concise member and provider-facing letters that represent Healthfirst. + Ability to work independently using computer applications like Microsoft Word, Excel, Teams, PowerPoint and SharePoint. + Highly organized with the ability to manage multiple priorities effectively. + Commitment to follow through on tasks and commitments. **Preferred Qualifications:** + Experience in coaching and mentoring staff to think critically and approach problem-solving strategically. + Ability to foster a culture of continuous improvement. + Demonstrated commitment to living Healthfirst values and culture drivers. + Familiarity with our leadership compass. + Prior work experience within a matrix organizational structure. + Familiarity with various areas within Healthfirst, such as claims configuration, provider operations, payment integrity, call center, care management, enrollment, billing, and utilization management. + Familiarity with A&G company policies and relevant regulations. + Understanding of claim processing, including billing and coding. + Knowledge of our authorization processes. + Experience with corporate email and virtual filing systems (e.g., Macess). + Familiarity with care management systems (e.g., TruCare, Hyland Onbase, SalesForce) + Knowledge of epaccess/ MARx/ HHAexchange. + Demonstrated ability to efficiently manage large caseloads for a team of specialists. + Skill in triage, prioritization, and oversight to ensure high-quality case resolution within regulatory timeframes. **Compliance & Regulatory Responsibilities: N/A** **License/Certification: N/A** WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.