Manager, Advocacy & Dispute Resolution

Christian Care Ministry Careers•Melbourne, FL

1d•$83,000 - $114,000•Onsite

About The Position

The Manager, (Medical Bill) Advocacy & Dispute Resolution is accountable for the end-to-end design, operation, and performance of provider payment inquiries and disputes, as well as the member balance bill Advocacy Program. This leader manages Negotiators, Paralegals, and Member Bill Advocates who work to protect members from unexpected out-of-network charges and resolve provider payment inquiries and disputes. The Manager ensures program compliance with the organization’s sharing program guidelines, oversees delegated third-party vendor performance against contracted service levels, delivers measurable financial protection to plan members, and provides data-driven insights to plan leadership. The position requires strength in people leadership, vendor management, regulatory knowledge, operational execution, and stakeholder communication. The role is based onsite at least four days of a five-day workweek in either the Orlando, Florida, or Melbourne, Florida, office. Occasional travel within the United States may be required, approximately 1–4 times per year. The position has supervisory responsibilities.

Requirements

Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a closely related field.
At least 5 years of experience in health plan operations, healthcare sharing ministry operations, member services, provider relations, and/or managed care.
At least 2 years of direct people management or team lead experience.
Direct experience managing or overseeing a Zelis Healthcare delegation or comparable payment-integrity/provider-dispute vendor relationship.
Demonstrated subject-matter expertise in provider payment dispute resolution, member billing protections, and applicable state laws affecting member medical billing.
Ability to manage delegated third-party vendor performance against contract service levels, including SLA monitoring, corrective-action management, and escalation handling.
Proficiency with case/customer management systems, such as Salesforce Health Cloud.
Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, and Teams.
Strong analytics skills, including the ability to create, manage, and interpret complex data reporting and translate it into meaningful insights.
Strong written, digital, and oral communication skills, including the ability to communicate messages that motivate broad audiences, including executives, to action.
Proven ability to manage cross-functional relationships in a regulated environment.
Must be at least 18 years old at the time of hire.
Willingness and ability to work onsite at least four days out of the five-day workweek in either the Orlando, Florida, or Melbourne, Florida, office.

Nice To Haves

Master’s degree in Healthcare Administration or Business Administration, or a Juris Doctorate (JD).
Experience in balance billing advocacy, provider payment resolution, or third-party arbitration proceedings.
Certified Managed Care Professional (CMCP) certification or equivalent managed care certification.
Experience managing a team in a contact center, appeals and grievance, or provider dispute environment.
Knowledge of Zelis Healthcare standards and operations.
Familiarity with Hybrid Multi-Band or multi-tier provider network plan/program structures.
Familiarity with healthcare sharing operating models, member sharing guidelines, and shared-eligibility determinations.

Responsibilities

Establish and continuously improve policies, procedures, workflows, and quality standards for the advocacy case lifecycle, including balance bill resolution, provider payment inquiries, and provider payment disputes.
Define program KPIs and success metrics with plan leadership, lead quarterly business reviews, and deliver monthly performance dashboards.
Maintain a risk register for high-dollar, legally complex, or member-sensitive cases and present quarterly risk summaries to the VP.
Design and implement staffing ramp strategies using the range model, activating additional FTEs when defined monthly case thresholds are sustained for more than 60 days.
Manage staffing levels, performance, coaching, and development for member advocates, paralegals, negotiators, and other Advocacy Team support roles.
Hold regular one-on-one meetings with team members to provide coaching and performance feedback and address conflict resolution promptly.
Design and deliver onboarding and training programs with the Training Team.
Designate and support embedded triage team leads to maintain effective day-to-day supervision.
Review all open cases weekly for compliance with resolution timelines, documentation standards, and communication requirements.
Act as the primary escalation authority for cases involving legal action, active collections, media attention, member disputes, or regulatory inquiries.
Authorize negotiation settlement parameters above established thresholds and approve cases proceeding to alternative dispute resolution or external legal counsel.
Establish and maintain policies, procedures, and quality standards for the full lifecycle of provider payment inquiries and disputes.
Define inquiry response-time and dispute-resolution targets and align internal standards with vendor and contract standards.
Review aged or unresolved payment disputes and escalate high-dollar, multi-party, member-sensitive, or precedent-setting disputes.
Track inquiry and dispute volume, resolution rates, average closure time, and root-cause categories; route systemic issues to Claims, Network Management, or Provider Relations for upstream correction.
Authorize settlement parameters and policy exceptions for disputes exceeding standard delegated authority thresholds.
Oversee vendor performance against contracted service-level agreements for provider payment inquiry and dispute response, including response times, resolution timelines, and escalation handling.
Monitor vendor response-time performance, inquiry closure rates, and dispute aging through operational reviews and contracted reporting.
Serve as the internal escalation point for vendor-handled inquiries and disputes requiring ministry-side decision-making, policy interpretation, or settlement authority beyond the vendor’s delegated threshold.
Coordinate corrective-action plans with vendors when performance falls below contracted service levels, document remediation, track it to closure, and verify return to compliance.
Conduct quarterly vendor contract performance reviews, document SLA performance, identify capacity or service-level concerns, and recommend renewal, renegotiation, or replacement actions to plan leadership and Vendor Management.
Maintain shared documentation with vendors covering case-handoff criteria, escalation protocols, settlement authority limits, and reporting standards.
Ensure advocacy program activities comply with the organization’s sharing program guidelines, applicable laws, plan documents, and disclosures.
Coordinate with Compliance on internal and external audits, corrective-action plans, and regulatory reporting.
Contribute to the exercise and expression of Christian Care Ministry’s beliefs.
Serve as the advocacy program’s primary liaison to Needs Processing, Network Management, Provider Relations, Member Services, Finance, Compliance, and Legal.
Present program performance results, including delegated-vendor performance, quarterly to plan leadership, the board of directors, and employer or member-group sponsors.
Manage vendor relationships for third-party arbitration platforms, legal research subscriptions, coding review services, and healthcare delegation.
Perform other duties as assigned.

Benefits

100% employer-paid medical coverage for employees and 99% for family.
Generous employer Health Savings Account (HSA) contributions.
Employer-paid life insurance equal to 3 times salary and long-term disability insurance.
Six weeks of paid parental leave for both mothers and fathers.
Choice of two dental plans.
Vision coverage.
Short-term disability coverage.
Accident, critical illness, and hospital indemnity coverage.
401(k) with up to a 4% match on Roth or traditional contributions.
Generous paid time off and 11 paid holidays.
Wellness plan with financial, occupational, mental/spiritual, and physical health incentives of up to $50 per month.
Employee Assistance Program, including no-cost in-person mental health visits and employee discounts.
Monetary anniversary awards program.
Monetary birthday awards.