• Oversees day-to-day adjudication operations, ensuring a controlled, disciplined, regulatorily compliant and exceptionally reliable operational environment. • Responsible for establishing and maintaining reports to support the efficacy of each service authorizations process. • Review and monitor encounter data submissions for accuracy, maintaining documentation and troubleshooting processes. • Engages with Enrollment & Eligibility to resolve data discrepancies impacting member benefits or provider assignments. • Conduct retrospective reviews and maintains reporting evaluating the accuracy, timeliness, and effectiveness of service authorization processes. • Monitors daily, weekly, and monthly inventory to anticipate risk and maintain a stable production environment.