Director, NSA IDR & State Compliance Operations

Zelis • St. Louis, MO

2d • $169,000 - $213,750 • Hybrid

About The Position

The Director of Compliance Operations is a key enterprise leader responsible for overseeing all operational, regulatory, and strategic aspects of No Surprises Act (NSA) related to, Independent Dispute Resolution (IDR), and State Arbitration programs. This role ensures the organization consistently delivers compliant, efficient, and high-quality outcomes across all applicable federal and state regulatory requirements. The Director will provide vision and leadership across a multi-layered team—including both US and global operations—and serves as the primary operational liaison for clients, regulators, and external vendor partners. Success in this role requires deep compliance expertise, advanced operational strategy, financial acumen, and an ability to navigate fast-evolving regulatory environments.

Requirements

• Bachelor’s degree in Business, Health Administration, Compliance, or related field; advanced degree preferred.
• 12+ years of experience in healthcare operations, regulatory compliance, managed care, claims, or arbitration programs.
• Deep expertise in the No Surprises Act, Federal IDR, and State Arbitration regulations and workflows.
• Proven leadership experience managing large, multi-site (onshore and offshore) operational teams.
• Demonstrated ability to connect operational performance to financial outcomes, including interpreting data, forecasting, and presenting findings to executives.
• Strong analytical, strategic thinking, and problem-solving abilities.
• Exceptional communication skills with experience engaging executive-level clients and partners.
• Strategic and financially minded operator with the ability to bridge compliance, analytics, and performance management.
• Skilled at translating regulatory complexity into operational execution.
• Collaborative leader who influences across teams and organizations.
• High integrity, compliance orientation, and commitment to quality.

Nice To Haves

• Experience with payers, TPAs, providers, regulators, or dispute resolution entities preferred.
• Background in arbitration case management or financial modeling preferred.
• Experience with regulatory workflow technology or automation platforms preferred.

Responsibilities

• Oversee end-to-end compliance operations for NSA related IDR, and State Arbitration, ensuring adherence to all federal and state requirements.
• Monitor CMS rulemaking and state-level updates to proactively adjust operational processes and internal controls.
• Partner with Legal, Compliance, and Product teams to interpret regulations and translate them into scalable workflows and documentation.
• Ensure audit-readiness, risk mitigation, accurate reporting, and regulatory transparency.
• Develop and execute a comprehensive strategy that aligns operational performance, compliance requirements, and downstream financial impact.
• Analyze and translate operational performance (win rates, processing times, arbitration outcomes, submission quality, error rates) into clear financial outcomes, including revenue impact, cost implications, and profitability.
• Provide forward-looking financial insights and modeling based on operational trends, regulatory changes, and volume shifts.
• Lead day-to-day operations across high-volume compliance workflows, optimizing for efficiency, accuracy, and financial outcomes.
• Identify automation opportunities, technology enhancements, and process redesign to improve quality and reduce cost.
• Implement KPIs, SLAs, dashboards, and operational scorecards that tie performance outcomes directly to financial results.
• Oversee budgeting, forecasting, staffing models, and capacity planning across onshore and global teams.
• Direct, mentor, and develop a diverse workforce spanning domestic and global operations.
• Ensure teams are trained and equipped to meet evolving regulatory and operational standards.
• Drive a culture of accountability, performance excellence, and continuous improvement.
• Serve as a senior-level point of contact for clients, regulatory partners, arbitrators, and third-party vendors.
• Build strong partnerships to align on expectations, performance outcomes, compliance obligations, and financial impacts.
• Oversee vendor contracts, performance monitoring, compliance standards, and escalation processes.
• Represent the organization in client governance, regulatory discussions, and strategic business reviews.

Benefits

• Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection.
• The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 1,001-5,000 employees