Manager, Independent Dispute Resolutions Operations

Job not on LinkedIn

🔥 12 hours ago

🐊 Florida, Illinois, +6 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🐎 Kentucky – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Lead and manage No Surprises Act Independent Dispute Resolution operations • Ensure timely, accurate, and compliant handling of federal and state dispute resolution activities • Oversee end-to-end IDR case administration, including dispute initiation, review, submission, determination, payment resolution, and case closure • Manage inventory, productivity, quality, service levels, and regulatory timelines in a high-volume environment • Lead, develop, and manage staff and contracted resources • Conduct workforce planning, coaching, performance management, and resource allocation • Monitor and analyze operational and financial performance metrics • Identify trends, risks, and opportunities to improve outcomes and efficiency • Maintain controls, documentation standards, policies, and audit readiness • Manage arbitration-related fees, payment determinations, reconciliations, and financial exposure tracking • Collaborate with Legal, Compliance, Regulatory Affairs, Claims, Provider Operations, Finance, and other stakeholders • Lead regulatory implementations, workflow enhancements, system changes, training efforts, and process improvement initiatives • Present operational updates, performance results, risks, and recommendations to leadership and cross-functional partners • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Bachelor's Degree in Healthcare Administration, Business Administration, Health Policy, Public Administration, Finance, related field or equivalent experience required • 5+ years in healthcare operations, claims, provider reimbursement, appeals and grievances, regulatory operations, compliance, dispute resolution, or a related healthcare function required • 2+ years management experience • Previous people leadership and supervisory experience, including hiring, onboarding, training, work assignment, coaching, performance management, and employee development • Proven ability to lead and motivate teams in a high-volume, fast-paced operational setting • 3+ years managed care or health insurance experience required • Experience with the No Surprises Act, Federal or state IDR, open negotiation, surprise billing requirements, CMS regulatory implementation, or related dispute-resolution operations preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K and stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity