CrawlJobs Logo

Director, NSA IDR & State Compliance Operations

zelis.com Logo

Zelis

Location Icon

Location:
United States , Atlanta

Category Icon
Category:

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

169000.00 - 213750.00 USD / Year

Job Description:

The Director of Compliance Operations is a key enterprise leader responsible for overseeing all operational, regulatory, and strategic aspects of No Surprises Act (NSA) related to, Independent Dispute Resolution (IDR), and State Arbitration programs. This role ensures the organization consistently delivers compliant, efficient, and high-quality outcomes across all applicable federal and state regulatory requirements. The Director will provide vision and leadership across a multi-layered team—including both US and global operations—and serves as the primary operational liaison for clients, regulators, and external vendor partners. Success in this role requires deep compliance expertise, advanced operational strategy, financial acumen, and an ability to navigate fast-evolving regulatory environments.

Job Responsibility:

  • Oversee end-to-end compliance operations for NSA related IDR, and State Arbitration, ensuring adherence to all federal and state requirements
  • Monitor CMS rulemaking and state-level updates to proactively adjust operational processes and internal controls
  • Partner with Legal, Compliance, and Product teams to interpret regulations and translate them into scalable workflows and documentation
  • Ensure audit-readiness, risk mitigation, accurate reporting, and regulatory transparency
  • Develop and execute a comprehensive strategy that aligns operational performance, compliance requirements, and downstream financial impact
  • Analyze and translate operational performance (win rates, processing times, arbitration outcomes, submission quality, error rates) into clear financial outcomes, including revenue impact, cost implications, and profitability
  • Provide forward-looking financial insights and modeling based on operational trends, regulatory changes, and volume shifts
  • Lead day-to-day operations across high-volume compliance workflows, optimizing for efficiency, accuracy, and financial outcomes
  • Identify automation opportunities, technology enhancements, and process redesign to improve quality and reduce cost
  • Implement KPIs, SLAs, dashboards, and operational scorecards that tie performance outcomes directly to financial results
  • Oversee budgeting, forecasting, staffing models, and capacity planning across onshore and global teams
  • Direct, mentor, and develop a diverse workforce spanning domestic and global operations
  • Ensure teams are trained and equipped to meet evolving regulatory and operational standards
  • Drive a culture of accountability, performance excellence, and continuous improvement
  • Serve as a senior-level point of contact for clients, regulatory partners, arbitrators, and third-party vendors
  • Build strong partnerships to align on expectations, performance outcomes, compliance obligations, and financial impacts
  • Oversee vendor contracts, performance monitoring, compliance standards, and escalation processes
  • Represent the organization in client governance, regulatory discussions, and strategic business reviews

Requirements:

  • Bachelor’s degree in Business, Health Administration, Compliance, or related field
  • advanced degree preferred
  • 12+ years of experience in healthcare operations, regulatory compliance, managed care, claims, or arbitration programs
  • Deep expertise in the No Surprises Act, Federal IDR, and State Arbitration regulations and workflows
  • Proven leadership experience managing large, multi-site (onshore and offshore) operational teams
  • Demonstrated ability to connect operational performance to financial outcomes, including interpreting data, forecasting, and presenting findings to executives
  • Strong analytical, strategic thinking, and problem-solving abilities
  • Exceptional communication skills with experience engaging executive-level clients and partners
  • Experience with payers, TPAs, providers, regulators, or dispute resolution entities preferred
  • Background in arbitration case management or financial modeling preferred
  • Experience with regulatory workflow technology or automation platforms preferred
  • Strategic and financially minded operator with the ability to bridge compliance, analytics, and performance management
  • Skilled at translating regulatory complexity into operational execution
  • Collaborative leader who influences across teams and organizations
  • High integrity, compliance orientation, and commitment to quality

Nice to have:

  • Experience with payers, TPAs, providers, regulators, or dispute resolution entities preferred
  • Background in arbitration case management or financial modeling preferred
  • Experience with regulatory workflow technology or automation platforms preferred
What we offer:
  • 401k plan with employer match
  • flexible paid time off
  • holidays
  • parental leaves
  • life and disability insurance
  • health benefits including medical, dental, vision, and prescription drug coverage

Additional Information:

Job Posted:
February 20, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Director, NSA IDR & State Compliance Operations

New

Restaurant Server

CyHawk Hospitality, Inc., franchisee for Perkins Restaurant and Bakery is now hi...
Location
Location
United States , Sioux City
Salary
Salary:
Not provided
perkinsrestaurants.com Logo
Perkins Restaurant & Bakery
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Reports to work well-groomed, in clean and proper uniform and at all times practices good personal hygiene
  • Greets guest in a courteous and respectable way when seated at station
  • Welcomes guests immediate upon seating with a non-scripted greeting
  • Using acquired menu knowledge, offers menu suggestions, answers questions and anticipates guests’ needs
  • Deliver Hot Food – Check completed food orders for accuracy, appearance and temperature, deliver to the table immediately
  • Deliver Perkins Service – Show a desire to please with your genuine hospitality, personality and specific suggestions at every step
  • Actively engage Guests who have concerns and remedy them
  • Ensure that each Guest is 100% satisfied with his/her dining experience
  • Clean – Keep tables/station, pantry line area and dining room common areas clean
  • Complete assigned Perkins cleaning system duties
Job Responsibility
Job Responsibility
  • Provides friendly and efficient service in a timely manner to guests according to company policies, procedures, programs and performance standards
  • Shows quests genuine hospitality while providing them with a memorable experience
  • Look like a professional and show sincerity with a positive, friendly attitude
  • Performs all duties to maximize guest satisfaction and quality of work environment as directed by Manager on Duty.
What we offer
What we offer
  • Supportive ownership that believes in family
  • Closed on Christmas Day
  • Yearly anniversary checks for continued employment*
  • Free Employee Meals and family discounts*
  • Competitive wages for your experience
  • Paychecks delivered weekly
  • Flexible hours & schedules
  • Structured training program for all positions
  • Referral bonus for great employees who recruit other great employees
  • Career path that rewards you financially for your advancement within the company*
  • Parttime
Read More
Arrow Right
New

Pharmacy Technician

At CVS Health, we’re building a world of health around every consumer and surrou...
Location
Location
United States , Indianapolis
Salary
Salary:
16.50 - 25.00 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
March 12, 2026
Flip Icon
Requirements
Requirements
  • Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
  • If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
  • If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
  • Regular and predictable attendance, including nights and weekends
  • Ability to complete required training within designated timeframe
  • Attention and Focus: Ability to concentrate on a task over a period of time
  • Ability to pivot quickly from one task to another to meet patient and business needs
  • Ability to confirm prescription information and label accuracy, ensuring patient safety
  • Customer Service and Team Orientation: Actively look for ways to help people, and do so in a friendly manner
  • Notice and understand patients’ reactions, and respond appropriately
Job Responsibility
Job Responsibility
  • Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
  • Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
  • Contributing to positive patient experiences by showing empathy and genuine care: creating heartfelt and personalized moments while serving patients at pick-up, drive-thru, and over the phone
  • keeping patients healthy by offering immunizations and other services at the register and over the phone
  • and demonstrating compassionate care by solving or escalating patient problems
  • Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team, such as accurately putting away medication deliveries and completing cycle counts, returns-to-stocks, waiting bin inventories, etc.
  • Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
  • actively seeking opportunities to expand clinical and technical knowledge needed to better assist patients
  • Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
  • voluntarily traveling to stores in the market to work shifts as needed by the business
What we offer
What we offer
  • Affordable medical plan options
  • a 401(k) plan (including matching company contributions)
  • an employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
  • Fulltime
Read More
Arrow Right
New

Full-Stack Engineer

Legora is on a mission: to redefine how legal work gets done. From the very star...
Location
Location
Sweden , Stockholm
Salary
Salary:
Not provided
Legora
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • A passionate engineer with a few years of experience building great products using cutting-edge technologies
  • You feel comfortable working across the entire tech stack, with focus on backend development
  • You’re autonomous and take pride in the code you write
  • You’re a problem solver who’s not afraid to come up with creative solutions and think holistically about software architecture
Job Responsibility
Job Responsibility
  • Architect and implement features end-to-end for our web platform
  • Take ownership of our codebase, balancing high-quality code, security and speed of development
  • Work with technologies such as React, Node.js, AWS, Azure and Kubernetes
  • Drive continuous improvement and challenge us, the industry and yourself
  • Fulltime
Read More
Arrow Right
New

Restaurant server waiter waitress

Perkins Restaurant is now hiring Servers for our Perkins Restaurant in Omaha. St...
Location
Location
United States , Omaha
Salary
Salary:
Not provided
perkinsrestaurants.com Logo
Perkins Restaurant & Bakery
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Reports to work well-groomed, in clean and proper uniform and at all times practices good personal hygiene
  • Greets guest in a courteous and respectable way when seated at station
  • Welcomes guests immediate upon seating with a non-scripted greeting
  • Using acquired menu knowledge, offers menu suggestions, answers questions and anticipates guests’ needs
  • Deliver Hot Food – Check completed food orders for accuracy, appearance and temperature, deliver to the table immediately
  • Deliver Perkins Service – Show a desire to please with your genuine hospitality, personality and specific suggestions at every step
  • Actively engage Guests who have concerns and remedy them
  • Ensure that each Guest is 100% satisfied with his/her dining experience
  • Clean – Keep tables/station, pantry line area and dining room common areas clean
  • Complete assigned Perkins cleaning system duties
Job Responsibility
Job Responsibility
  • Provides friendly and efficient service in a timely manner to guests according to company policies, procedures, programs and performance standards
  • Shows quests genuine hospitality while providing them with a memorable experience
  • Look like a professional and show sincerity with a positive, friendly attitude
  • Performs all duties to maximize guest satisfaction and quality of work environment as directed by Manager on Duty
What we offer
What we offer
  • Supportive ownership that believes in family
  • Closed on Christmas Day
  • Yearly anniversary checks for continued employment
  • Free Employee Meals and family discounts
  • Competitive wages for your experience
  • Paychecks delivered weekly
  • Flexible hours & schedules
  • Structured training program for all positions
  • Referral bonus for great employees who recruit other great employees
  • Career path that rewards you financially for your advancement within the company
  • Parttime
Read More
Arrow Right
New

Senior Engineer – (Systems Engineering, Enterprise Infra & Platform Support)

The Senior Infrastructure & Platform Support Engineer provides end-to-end techni...
Location
Location
United States , Chevy Chase
Salary
Salary:
80000.00 - 215000.00 USD / Year
Geico
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Experience leading engineering efforts or owning internal, enterprise-scale platforms and working directly with enterprise customers
  • Familiarity with enterprise application lifecycle (selection, deployment, user adoption, decommission, integration layers)
  • Strong background in enterprise infrastructure supporting Windows and Linux systems, including builds, configuration, hardening, and troubleshooting
  • Advanced skills with Windows Server, Active Directory, authentication protocols (Kerberos / LDAP / SAML / OAuth), and Azure AD/identity integrations
  • Solid Linux administration experience (Ubuntu, RHEL, or equivalent), with certifications preferred
  • Proficiency in automation and scripting (PowerShell, Bash, Python)
  • Strong understanding of networking fundamentals: TCP/IP, DNS, DHCP, routing, VPNs, firewalls, load balancers, VLANs, and secure connectivity
  • Hands-on experience with cloud platforms (Azure/AWS), hybrid environments, virtualization (vSphere/Hyper-V), and containers (Docker, Kubernetes)
  • Knowledge of monitoring and observability tools, such as Prometheus, Grafana, or equivalent solutions
  • Familiarity with database concepts, performance tuning, and integration of MySQL/PostgreSQL/SQL Server/Oracle with enterprise systems
Job Responsibility
Job Responsibility
  • Provide technical leadership to ensure strong engineering standards and operational excellence
  • Support, configure, and maintain both Linux and Windows server platforms, including application servers, integration components, and system services
  • Design and implement infrastructure solutions for workplace technologies including but not limited to digital mailroom, physical security & safety, and real estate facility management technology platforms—covering on-prem systems, hybrid setups, and SaaS applications
  • Build production-ready configurations emphasizing reliability, maintainability, scalability, and testability
  • Lead incident response, troubleshooting, root-cause analysis, and drive ongoing performance optimization
  • Execute DevOps activities including CI/CD pipeline management, automation scripting, monitoring setup, and Infrastructure as Code
  • Ensure platform observability through logging, alerting, dashboards, and automated health checks
  • Apply secure design practices, compliance controls, network segmentation, encryption, and access management
  • Manage platform lifecycle activities such as patching, upgrades, capacity planning, backups, disaster recovery and identifying opportunities for automation and standardization
  • Collaborate with cross-functional teams, vendors, and senior engineers, communicating clearly with technical and non-technical stakeholders
What we offer
What we offer
  • Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family’s overall well-being
  • Financial benefits including market-competitive compensation
  • a 401K savings plan vested from day one that offers a 6% match
  • performance and recognition-based incentives
  • and tuition assistance
  • Access to additional benefits like mental healthcare as well as fertility and adoption assistance
  • Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year
  • Fulltime
Read More
Arrow Right
New

Sr Data Scientist

Identifies business trends and problems through complex data analysis. Interpret...
Location
Location
United States , SANTA ROSA
Salary
Salary:
135600.00 - 151300.00 USD / Year
firstam.com Logo
First American Financial
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s degree or equivalent experience in a quantitative field such as Mathematics, Statistics, Computer Science, Engineering, Economics, or related discipline
  • Master’s or PhD preferred
  • 5–7+ years of professional experience building, validating, deploying, and monitoring predictive and machine learning models in production environments
  • Strong programming expertise in Python with hands-on experience building end-to-end ML solutions
  • Experience with MLflow (or similar model lifecycle tools) for experiment tracking, model versioning, and deployment management
  • Experience working with SQL and large-scale data processing frameworks such as Apache Spark
  • Experience designing scalable data solutions in modern data platforms
  • experience with Microsoft Fabric is a plus
  • Proven experience applying machine learning techniques (e.g., regression, classification, clustering, ensemble methods, NLP, etc.)
  • Strong communication skills with the ability to explain complex analytical concepts to non-technical stakeholders
Job Responsibility
Job Responsibility
  • Leverage expertise in handling large, complex datasets to perform exploratory data analysis, feature engineering, and statistically sound sample design
  • Build, validate, deploy, and enhance complex predictive and machine learning models using data from multiple structured and unstructured sources to materially improve business outcomes
  • Design, build, deploy, and monitor machine learning models in production environments, ensuring scalability, reliability, and performance
  • Implement model lifecycle management best practices including versioning, experiment tracking, monitoring, retraining strategies, and performance optimization (e.g., MLflow or similar frameworks)
  • Automate feedback loops for algorithms and models in production while creating scalable, repeatable data science processes and production-grade data products
  • Design and execute experiments (A/B testing, causal inference frameworks) to evaluate model performance and business impact
  • Act as a technical subject matter expert, recommending and developing innovative analytical approaches aligned with strategic priorities
  • Translate complex analytical findings into clear business insights and present results to executive and non-technical audiences
  • Mentor junior data scientists and contribute to establishing enterprise best practices in modeling, governance, and documentation
  • Collaborate with data engineering teams to ensure robust pipelines, high data quality, and scalable model deployment
What we offer
What we offer
  • medical
  • dental
  • vision
  • 401k
  • PTO/paid sick leave
  • employee stock purchase plan
  • Fulltime
Read More
Arrow Right
New

Legal Counsel - Regulatory and Compliance

As Regulatory & Compliance Counsel at Legora, you will be central to our legal t...
Location
Location
Sweden , Stockholm
Salary
Salary:
Not provided
Legora
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Law degree (LL.M. or equivalent) from Sweden, the UK, or an EU-jurisdiction, qualified to practice in that country
  • Proficiency in both spoken and written Swedish and English
  • 3-6 years of experience at a top-tier law firm and/or as an in-house legal counsel
  • Strong experience negotiating B2B SaaS agreements and supporting commercial teams
  • Proven expertise advising on GDPR, CCPA, and cross-border privacy compliance
  • Familiarity with ISO standards and global compliance frameworks (e.g. AICPA SOC)
  • Strong legal judgment and confidence in making decisions independently
  • Highly organised, responsive, and solutions-oriented
  • Comfortable working across time zones in a global environment, and owning your priorities
  • You thrive in a fast-paced, dynamic entrepreneurial environment and rapidly evolving business setting
Job Responsibility
Job Responsibility
  • Provide compliance oversight and guidance to senior stakeholders across operational, commercial and product teams on regulatory matters, risk assessment, and compliance frameworks for new services, processes, contracts, partnerships, and supply chains
  • Review and provide compliance input on commercial contracts,ensuring adherence to regulatory requirements and company policies
  • Conduct compliance assessments of product designs, data flows, and operational processes, identifying regulatory risks and developing risk mitigation strategies
  • Contribute to building legal infrastructure: templates, playbooks, and internal tooling, including how we use Legora to operationalize legal work and collaborate across teams
  • Develop and maintain privacy compliance programs, conduct data protection impact assessments, and ensure ongoing compliance with applicable data protection regulations
  • Establish efficient and scalable compliance frameworks and monitoring systems, developing compliance policies and guidelines that enable teams to proactively integrate regulatory requirements and compliance controls into products and processes
  • Fulltime
Read More
Arrow Right
New

Inventory Clerk

We are looking for a detail-oriented Inventory Clerk to join our team in Odessa,...
Location
Location
United States , Odessa
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven experience in administrative support and inventory tracking
  • Strong knowledge of accounting processes, including reconciliation of financial documents
  • Proficiency in coding invoices and managing purchase orders
  • Familiarity with filing systems, both paper and electronic
  • Ability to conduct annual physical inventory audits and maintain asset records
  • Skilled in using 10-key accounting tools for data entry tasks
  • Excellent organizational and multitasking abilities
  • Effective communication skills to collaborate with team members
Job Responsibility
Job Responsibility
  • Perform accurate reconciliation of receipts and purchase orders to maintain financial records
  • Organize and manage administrative tasks including filing, scanning, and data entry
  • Track inventory levels and assist with annual physical inventory audits
  • Code and process invoices efficiently to support accounting operations
  • Collaborate with team members to ensure seamless tracking of expenses and reconciliation reports
  • Maintain numeric and paper filing systems for easy retrieval and documentation
  • Handle administrative oversight to streamline office operations
  • Utilize 10-key accounting skills to input and verify data accurately
  • Assist in reconciling credit card, bank account, and expense reports
  • Support ongoing projects to ensure organizational goals are met within deadlines
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan
Read More
Arrow Right