Network Quality Manager
About The Position
The Network Quality Manager oversees and optimizes provider network performance, with an emphasis on preventing and resolving reimbursement disputes and mitigating risk in the workers’ compensation bill review process. The role is accountable for ensuring network partners meet contractual, regulatory, and operational expectations while working with internal stakeholders, provider networks, and clients to reduce disputes, improve resolution outcomes, and protect financial and reputational interests while maintaining service quality. The manager develops network policies and workflows, analyzes provider appeals and adjustments, and works with legal, clinical, compliance, and analytics teams to improve dispute handling and network performance. The position also owns the lifecycle of network-related solutions, translates client requirements and regulatory changes into product improvements, and contributes subject-matter expertise across internal teams and external partnerships.
Requirements
- 7–10 years of experience in network management and/or group health.
- Experience working in or with bill review disciplines.
- Strong written and verbal communication skills.
- Experience working in a matrixed organization and managing multiple stakeholders effectively.
- Excellent relationship management and issue resolution skills.
- Excellent organizational and analytical skills.
Nice To Haves
- Familiarity working with offshore teams.
- Experience managing talent at all levels.
- Proven experience in vendor management.
Responsibilities
- Develop and enforce network policies and workflows related to provider reimbursement disputes, PPO discounts, provider contracts, and post-bill review reductions.
- Analyze provider appeals and adjustments to identify trends and root causes, and recommend data-driven improvements.
- Collaborate with legal, clinical, and compliance teams to resolve provider disputes efficiently and consistently.
- Promote proactive communication with providers to improve understanding of reimbursement processes and reduce conflict.
- Design and maintain network performance dashboards tracking metrics.
- Work with analytics teams to evaluate network quality, effectiveness, and impact on claims outcomes.
- Own the lifecycle of network-related solutions that enhance compliance, savings, and stakeholder satisfaction.
- Translate client requirements and regulatory changes into actionable product improvements.
- Monitor market and regulatory trends to guide product innovation and maintain competitive advantage.
- Serve as a subject matter expert on network products, provider performance, and dispute processes.
- Partner with internal teams, including sales, account management, RFPs, and product launches.
- Collaborate with external vendors and partners.
Benefits
- Competitive salaries and benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
