Manager, Healthcare Negotiations

Job Description

Job Description

The range for this role is $83,000 to $114,000

Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education.

Interested applicants must be willing and able to work onsite full time in either our Orlando, FL or Melbourne, FL office.   

The Mission

At Christian Care Ministry, we strive to follow the early church example that we see in the book of Acts in the Bible, that modeled Christians helping one another and sharing in one another’s burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we look to live out that early church example. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God and our Members to the best of our ability.

The Job

Summary  

The Manager, (Medical Bill) Advocacy & Dispute Resolution is accountable for the end-to-end design, operation, and performance of provider payment inquiry and disputes as well as the member balance bill Advocacy Program. This leader manages a team of Negotiators, Paralegals, and Member Bill Advocates whose mission is to protect members from unexpected out-of-network charges and to resolve provider payment inquiries and disputes. The Manager ensures the program operates in compliance with the organization’s sharing program guidelines, oversees delegated third-party vendor performance against contracted service levels — including Zelis Healthcare (or other contracted vendor) for delegated provider inquiry and dispute response — delivers measurable financial protection to plan members, and provides data-driven program insights to plan leadership. The role requires equal strength in people leadership, vendor management, regulatory knowledge, operational execution, and stakeholder communication.

Essential Duties and Responsibilities

Program Leadership & Strategy

• Establish and continuously improve program policies, procedures, workflows, and quality standards for the full advocacy case lifecycle, including balance bill resolution, provider payment inquiries, and provider payment disputes
• Define program KPIs and success metrics in collaboration with plan leadership; lead quarterly business reviews and deliver monthly performance dashboards
• Develop and maintain a risk register for high-dollar, legally complex, or member-sensitive cases; present risk summary to VP quarterly
• Design and implement the staffing ramp strategy using the range model, activating additional FTEs when defined monthly case thresholds are sustained for 60+ days

People Leadership

• Provide effective management of staffing levels, performance, coaching, and development of member advocates, paralegals, negotiators and other Advocacy Team support roles
• Conduct regular 1:1 meeting with team members to ensure coaching, performance feedback and conflict resolution is addressed timely
• Design and deliver onboarding and training programs in coordination with the Training Team to ensure effective knowledge transfer, cross-functional education, and delivered quality to members and providers
• Designate and support embedded triage team leads to maintain effective day-to-day supervision
• Case Oversight & Escalation
• Review all open cases weekly to ensure compliance with resolution timelines, documentation standards, and communication requirements
• Serve as primary escalation authority for cases involving legal action, active collections, media attention, member disputes, or regulatory inquiries
• Authorize negotiation settlement parameters above negotiation-defined thresholds and approve cases proceeding to alternative dispute resolution or external legal counsel

Provider Payment Inquiries & Disputes

• Establish and maintain policies, procedures, and quality standards covering the full lifecycle of provider payment inquiries and disputes
• Define inquiry response-time and dispute resolution targets; align internal standards to vendor and contract standards to deliver consistent provider and member experiences
• Review aged or unresolved payment disputes regularly and serve as primary escalation point for high-dollar, multi-party, member sensitive, or precedent-setting disputes
• Track inquiry and dispute volume, resolution rates, average closure time, and root-cause categories; identify recurring patterns and route systemic issues to Claims, Network Management, or Provider Relations for upstream correction
• Authorize settlement parameters and policy exceptions for disputes that exceed standard delegated authority thresholds

Delegated Vendor Oversight

• Oversee vendor performance against contracted service level agreements related to provider payment inquiry and dispute response; including response-time SLAs, dispute resolution timelines, and escalation-handling commitments
• Monitor vendor response-time performance, inquiry closure rate, and dispute aging through scheduled operational reviews and the contracted reporting cadence
• Serve as the organization’s primary internal escalation point for vendor-handled inquiries and disputes that require sharing-ministry-side decisioning, policy interpretation, or settlement authority above vendor’s delegated threshold
• Coordinate corrective-action plans with vendors when performance falls below contracted service levels; document remediation, track to closure, and verify return to compliance 
• Conduct quarterly contract performance reviews with vendors; document SLA performance, surface vendor capacity or service-level concerns, and recommend renewal, renegotiation, or replacement actions to plan leadership and Vendor Management
• Maintain shared documentation between the internal advocacy team and vendor covering case-handoff criteria, escalation protocols, settlement authority limits, and reporting standards

Regulatory Compliance

• Ensure advocacy program activities comply with the organization’s sharing program guidelines, applicable laws, and required plan documents and disclosures
• Coordinate with Compliance on internal and external audits, correction action plans, and any regulatory reporting
• Contribute to the exercise and expression of Christian Care Ministry’s beliefs

Stakeholder Relations & Reporting

• Serve as the advocacy program’s primary liaison to Needs Processing, Network Management, Provider Relations, Member Services, Finance, Compliance and Legal departments
• Present program performance results — including delegated-vendor performance — to plan leadership, the board of directors, and employer or member-group sponsors on a quarterly basis
• Manage vendor relationships for third-party arbitration platforms, legal research subscriptions, coding review services, and the vendor healthcare delegation
• All other duties as assigned

Essential Skills & Abilities

• Demonstrated skill and subject matter expertise of provider payment dispute resolution, member billing protections, and applicable state laws affecting member medical billing
• Proven ability to manage delegated third-party vendor performance against contract service levels, including SLA monitoring, correction-action management, and escalation handling
• Proficient with case/customer management systems (such as Salesforce Health Cloud)
• Proficient with Microsoft Office Suite (Word, Excel, Outlook, PowerPoint, Teams)
• Strong Analytics skill – able to create, manage, and easily read complex data reporting and translate it to meaningful insights
• Communication skill – able to effectively produce and communicate in written, digital, and oral formats messages that motivate others to action across wide audiences (including executive levels)
• Proven ability to manage cross-functional relationships in a regulated 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

Core Competencies/Demonstrable Behaviors  

• Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose.  This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction.  Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
• Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
• Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence.  Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
• Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment
• Leadership – ability to effectively lead cohesive, unified, high performing teams

Education and/or Experience  

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a closely related field; Masters’ degree in Healthcare Administration, Business Administration, or Juris Doctorate (JD) preferred
• Minimum 5 years of experience in health plan operations, healthcare sharing ministry operations, member services, provider relations, and/or managed care required; preference given to those with experience in balance billing advocacy, provider payment resolution, or third-party arbitration proceedings experience
• Minimum 2 years of direct people management or team lead experience required
• Direct experience managing or overseeing a Zelis Healthcare delegation or comparable payment-integrity/provider dispute vendor relationship required
• Certified Managed Care Professional (CMCP) or equivalent managed care certification preferred
• Experience managing a team in a contact center, appeals & grievance, or provider dispute environment preferred

Supervisory Responsibilities  

This job has supervisory responsibilities

Travel

This role may require occasional travel within the US 1-4 times per year

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:

• 100% paid Medical for employees/99% for family
• Generous employer Health Savings Account (HSA) contributions
• Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
• 6 weeks of paid parental leave (for both mom and dad)
• Dental - two plans to choose from
• Vision
• Short-term Disability
• Accident, Critical Illness, Hospital Indemnity
• 401(k) – up to 4% match on ROTH or Traditional contributions
• Generous paid-time off and 11 paid holidays
• Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo 
• Employee Assistance Program including no cost, in-person mental health visits and employee discounts
• Monetary Anniversary Awards Program
• Monetary Birthday Awards

Minimum Age Requirement: Due to the nature of the responsibilities associated with this position—including independent decision-making, access to confidential information, and potential exposure to regulated environments—candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.

A program of Christian Care Ministry, Medi-Share is a healthcare sharing ministry where members share each other’s eligible medical bills. Its pillars are:

GOD-HONORING healthcare
AFFORDABLE choice
ACCEPTABLE under the law

In 1993, a formalized approach to sharing healthcare burdens began with the Medi-Share program. From small beginnings, this big idea took root. More than 30 years later, the Medi-Share program serves over 400,000 members, and more than $2.5 billion dollars in medical bills have been shared and discounted.

Company Description

A program of Christian Care Ministry, Medi-Share is a healthcare sharing ministry where members share each other’s eligible medical bills. Its pillars are:\r\rGOD-HONORING healthcare\rAFFORDABLE choice\rACCEPTABLE under the law \r\rIn 1993, a formalized approach to sharing healthcare burdens began with the Medi-Share program. From small beginnings, this big idea took root. More than 30 years later, the Medi-Share program serves over 400,000 members, and more than $2.5 billion dollars in medical bills have been shared and discounted.