Manager, Provider Dispute Resolution

Zelis•US FL Remote, FL

5d•Hybrid

About The Position

The Manager, Provider Dispute Resolution is responsible for leading the operational performance, quality, compliance, workforce strategy, and continuous improvement of Zelis' Federal Independent Dispute Resolution (IDR) and related Out of Network Post Pay operations. This role drives operational excellence through data-driven decision making, AI-enabled workflow adoption, process optimization, and talent development while ensuring exceptional service delivery for clients, providers, and members. The Manager partners closely with key stakeholders, such as Product, Technology, Client Management, and other key partners to improve operational performance, influence product and workflow enhancements, and support enterprise initiatives that improve efficiency, scalability, and customer outcomes. This leader creates an environment of accountability, innovation, and continuous improvement while developing high-performing teams capable of adapting to evolving business and regulatory requirements.

Requirements

Bachelor's degree in a related discipline, or equivalent combination of experience.
8+ years of progressive healthcare operations experience in claims, provider dispute resolution, payment integrity, revenue cycle, or related healthcare operations.
5+ years of people leadership experience managing operational teams and business performance.
Demonstrated success leading operational process improvement initiatives that produced measurable business results.
Experience managing operational inventories, workforce planning, productivity, quality, and service-level performance.
Strong analytical skills with the ability to leverage operational data to identify trends, solve complex problems, and drive informed business decisions.
Excellent communication, presentation, and stakeholder management skills with the ability to influence cross-functional teams.
Proven ability to lead through change while balancing operational execution with strategic priorities.

Nice To Haves

Experience supporting Federal Independent Dispute Resolution (IDR), No Surprises Act (NSA), Out of Network claims, Pricing Operations, or Payment Integrity.
Experience leading automation initiatives, AI-enabled workflows, digital transformation, or operational technology implementations.
Experience managing matrixed and/or global teams.
Lean, Six Sigma, Agile, or other continuous improvement certification.
Experience utilizing business intelligence, operational reporting, and workflow management platforms.

Responsibilities

Lead the day-to-day operational execution of Federal IDR and Out of Network Post Pay functions, ensuring achievement of quality, productivity, compliance, financial, and service-level objectives.
Develop and execute operational plans that improve business performance, customer experience, operational efficiency, and organizational effectiveness.
Establish, monitor, and communicate operational KPIs, business metrics, and performance trends while driving accountability for measurable business outcomes.
Utilize data and operational insights to proactively identify risks, workflow bottlenecks, and opportunities for continuous improvement.
Balance operational priorities while ensuring timely, accurate, and compliant claim dispute resolution.
Champion continuous improvement by identifying opportunities to redesign workflows, simplify processes, and eliminate operational inefficiencies.
Drive adoption and optimization of AI-enabled workflows, automation technologies, and operational tools that improve productivity, quality, scalability, and associate effectiveness.
Partner with Product teams to translate operational challenges into system enhancements, automation opportunities, and future product capabilities.
Support implementation of new operational processes, technologies, and business initiatives while ensuring successful organizational adoption.
Develop inventory management strategies utilizing forecasting, workload balancing, capacity planning, and workforce optimization techniques.
Manage staffing levels, resource allocation, scheduling, and organizational structure to support changing business volumes and service expectations.
Monitor inventory health, backlog performance, throughput, and cycle times while implementing corrective actions as necessary.
Partner with leadership to develop flexible staffing models that support evolving operational demands.
Ensure operational compliance with Federal Independent Dispute Resolution (IDR), the No Surprises Act (NSA), client-specific requirements, and internal operational standards.
Monitor operational risks, workflow exceptions, audit findings, and regulatory changes while implementing sustainable corrective actions.
Promote operational consistency through standardized procedures, quality controls, and governance practices.
Maintain awareness of healthcare industry trends, regulatory updates, and operational best practices that impact Out of Network Post Pay operations.
Build strong partnerships across key stakeholders to align priorities and improve business outcomes.
Influence operational strategy by providing business insights, performance trends, and recommendations that support enterprise decision-making.
Collaborate with stakeholders to improve workflow design, operational processes, reporting capabilities, and customer experience.
Present operational performance, forecasts, risks, and improvement recommendations to leadership and business partners.
Build and develop a high-performing team through coaching, performance management, career development, succession planning, and continuous feedback.
Foster a culture of accountability, trust, innovation, collaboration, and responsible experimentation aligned with Zelis leadership expectations.
Lead through change by communicating priorities clearly, building organizational alignment, and helping associates successfully adapt to evolving business needs.
Establish clear performance expectations while recognizing achievements and proactively addressing performance concerns.
Promote associate engagement, continuous learning, and professional growth while encouraging adoption of AI-enabled tools and new ways of working.