Manager, Provider Dispute Resolution

About this role

At Zelis, we Get Stuff Done. So, let’s get to it!     A Little About Us   Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.    A Little About You   You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview 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.

What you do: Operational Leadership & Business Performance • 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. 

Process Improvement, Innovation & AI • 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. 

Workforce, Inventory & Resource Management • 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. 

Compliance & Operational Governance • 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. 

Cross-Functional Leadership • 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. 

Leadership & Team Development • 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 wi

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