Manager, Independent Dispute Resolutions Operations

This is a fully remote position, open to applicants in Florida, +7 more states.

📋 Description

• Oversee and direct operations related to the No Surprises Act Independent Dispute Resolution.

• Ensure that federal and state dispute resolution activities are handled in a timely, accurate, and compliant manner.

• Manage the entire process of IDR case administration, which includes dispute initiation, review, submission, determination, payment resolution, and case closure.

• Supervise inventory, productivity, quality, service levels, and regulatory timelines within a high-volume environment.

• Lead, develop, and manage both staff and contracted resources effectively.

• Conduct workforce planning, coaching, performance management, and resource allocation strategies.

• Monitor and evaluate operational and financial performance metrics.

• Identify trends, risks, and opportunities to enhance outcomes and operational efficiency.

• Maintain adherence to controls, documentation standards, policies, and audit readiness.

• Oversee arbitration-related fees, payment determinations, reconciliations, and tracking of financial exposure.

• Collaborate with Legal, Compliance, Regulatory Affairs, Claims, Provider Operations, Finance, and other stakeholders.

• Drive regulatory implementations, workflow improvements, system modifications, training initiatives, and process enhancement projects.

• Provide operational updates, performance insights, risks, and recommendations to leadership and cross-functional partners.

• Perform additional duties as assigned.

• Adhere to all company policies and standards.

⛳️ Requirements

• Must have authorization to work in the U.S. without the need for employment-based visa sponsorship, now or in the future.

• A Bachelor's Degree in Healthcare Administration, Business Administration, Health Policy, Public Administration, Finance, or a related field, or equivalent experience, is required.

• A minimum of 5 years in healthcare operations, claims, provider reimbursement, appeals and grievances, regulatory operations, compliance, dispute resolution, or a comparable healthcare function is necessary.

• At least 2 years of management experience is required.

• Previous experience in people leadership and supervision, including hiring, onboarding, training, work assignment, coaching, performance management, and employee development is essential.

• A proven track record of leading and motivating teams in a high-volume, fast-paced operational environment is required.

• A minimum of 3 years of experience in managed care or health insurance is required.

• Familiarity with the No Surprises Act, Federal or state IDR, open negotiation, surprise billing requirements, CMS regulatory implementation, or similar dispute-resolution operations is preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance coverage.

• 401K and stock purchase plans available.

• Tuition reimbursement offered.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.

• We are an equal opportunity employer committed to fostering diversity.