Manager, Provider Dispute Resolution

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 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. What you’ll bring: 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. Preferred skills: 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. Travel Requirements: Ability to travel domestically up to 10%. Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies. While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email View email address on click.appcast.io. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time. #J-18808-Ljbffr LE011 Zelis Claims Integrity, LLC