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We are seeking a strategic, analytical risk manager to oversee and optimize provider network performance with a strong emphasis on dispute avoidance, dispute resolution, and risk mitigation within the workers’ compensation bill review process. In this role, you will act as the central point of accountability for provider reimbursement disputes, ensuring network partners operate in alignment with contractual, regulatory, and operational expectations. You will collaborate closely with internal stakeholders, provider networks, and clients to reduce dispute volume, improve resolution outcomes, and protect financial and reputational risk while maintaining high service quality.
Job Responsibility:
Develop and enforce network policies and workflows to provider reimbursement disputes related to PPO discounts, provider contracts, and post-bill review reductions
Analyze provider appeals and adjustments to identify trends and root causes, recommending data-driven improvements
Collaborate with legal, clinical, and compliance teams to resolve provider disputes efficiently and consistently
Promote proactive communication with providers to enhance understanding of reimbursement processes and reduce conflict
Design and maintain network performance dashboards tracking metrics
Collaborate 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 the 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
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 communications
Experience working in a matrixed organization and effective with multi-stakeholder management
Excellent relationship management and issue resolution skills
Enjoys managing talent at all levels
familiarity working with offshore teams a plus
Proven experience in vendor management
Excellent organizational, analytical, and communication skills
What we offer:
Possibility for remote and hybrid work opportunities