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Manager, Independent Dispute Resolutions Operations
Centene Corporation. Lead and manage No Surprises Act Independent Dispute Resolution operations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing Independent Dispute Resolution operations, ensuring compliance with the No Surprises Act, and leading teams in a high-volume healthcare environment. Proficient in operational performance analysis, regulatory implementation, and financial management within healthcare operations.
Highest-signal resume keywords
Independent Dispute Resolution ManagementHealthcare Operations ManagementRegulatory ComplianceTeam Leadership and DevelopmentFinancial Performance Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Dispute ResolutionClaims ManagementRegulatory OperationsPerformance ManagementFinancial Exposure TrackingWorkflow EnhancementsProcess ImprovementData AnalysisCase AdministrationHealthcare Policy
Soft Skills
LeadershipCoachingCommunicationProblem-SolvingTeam Motivation
Industry Keywords
No Surprises ActManaged CareHealth InsuranceCompliance StandardsProvider ReimbursementSurprise Billing RequirementsCMS Regulatory ImplementationHigh-Volume EnvironmentOperational MetricsAudit Readiness
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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