Manager, Provider Dispute Resolution
Core
Leading operational performance, quality, compliance, workforce strategy, and continuous improvement for Federal Independent Dispute Resolution (IDR) and Out of Network Post Pay operations.
Role type
Manager, Healthcare Operations (Dispute Resolution)
Builds
Operational workflows for claim dispute resolution and payment integrity
Domain
Healthcare / Insurance / Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Healthcare operations management, Federal IDR compliance, Out of Network Post Pay expertise, workforce planning, process improvement, data-driven decision making, stakeholder management, team leadership, change management, analytical problem solving
Preferred skills
No Surprises Act (NSA) experience, automation/AI workflow implementation, global team management, Lean/Six Sigma/Agile certification, business intelligence tools
Technologies
AI-enabled workflows, automation tools, business intelligence platforms
Responsibilities
Lead day-to-day operational execution of Federal IDR and Out of Network Post Pay functions; Develop and execute operational plans to improve business performance and efficiency; Establish and monitor operational KPIs and performance trends; Champion continuous improvement by redesigning workflows and eliminating inefficiencies; Manage staffing levels, resource allocation, and inventory health; Ensure operational compliance with Federal IDR and the No Surprises Act; Build and develop high-performing teams through coaching and performance management; Partner with Product and Technology teams to translate operational challenges into system enhancements
Seniority
Manager, hands-on leadership
